Benjamin Wakefield, DPT, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

LPT-31115 Issued in AZ

Practice address

1510 S Riordan Ranch St
Flagstaff, AZ 86001-6372

Phone

(928) 214-7303

NPI assigned

Jan 30, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physio Shop Flagstaff LLCGroup PAC ID 7719416304, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physio Shop Flagstaff LLC

  • Physical Therapy Clinic/Center
  • Flagstaff, AZ
  • NPI 1407674872

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• The Physio Shop LLC

  • Physical Therapy Clinic/Center
  • Flagstaff, AZ
  • NPI 1134524234

  Physical Therapist

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1982235792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S RIORDAN RANCH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860016372",
            "telephone_number": "928-214-7303",
            "fax_number": "928-214-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S RIORDAN RANCH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860016372",
            "telephone_number": "928-214-7303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKEFIELD",
        "first_name": "BENJAMIN",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-30",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AZ",
            "license": "LPT-31115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001418",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara J Wagar, RPH
• Garth Wagenman, PT
• Stephanie Wagner, M.S. CCC-SLP
• Taylor Wahl-Fabrega, RD
• Samantha Wahl, LMSW
• Walgreen Co
• Walgreen Co
• Sherry Walka, FNP-C
• Jennifer A Walker, PA
• Roxanne Walker, LCSW

• Orthopedic Physical Therapist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Orthopedic Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.