Basic Information
| Provider Information | |||||||||
| NPI: | 1346818044 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAFFOON | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | CARTHRAE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 VLIET DR | ||||||||
| Address2: | |||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088442229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082854266 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5393 S CALLE SANTA CRUZ STE 107 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857063556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202250129 | ||||||||
| FaxNumber: | 5202440000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2021 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.