Active NPI
Benjamin F Graves, DPT
- Physical Therapist
- San Angelo, TX
National Provider Identifier
1720828726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1392858
- Practice address
- 3001 S Jackson St
San Angelo, TX 76904-5129 - Phone
- (325) 223-6300
- NPI assigned
- May 28, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1392858 | TX | Primary |
Addresses
Primary practice location
3001 S Jackson St
San Angelo, TX 76904-5129
Mailing address
4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3537
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1392858 | Other | TX | COMMERCIAL |
| 1392858 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240826004114 | TX | Practitioner - Physical Therapist in Private Practice | 9638618341 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716854400000",
"number": "1720828726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 HARTFORD ST",
"city": "ABILENE",
"state": "TX",
"postal_code": "796054603",
"telephone_number": "325-793-3537",
"fax_number": "325-793-3587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 S JACKSON ST",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769045129",
"telephone_number": "325-223-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVES",
"first_name": "BENJAMIN",
"middle_name": "F",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-28",
"last_updated": "2024-05-28",
"certification_date": "2024-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1392858",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL",
"identifier": "1392858",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1392858",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.