Individual ProviderBenjamin WeissPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address14392 91st Pl N, Maple Grove, MN 55369-8530(605) 393-7169PECOS EnrollmentBased on the most recent information from CMS, provider Benjamin Weiss does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1093250391Provider TypeIndividualFull NameWeiss, BenjaminCredentialPT, DPTGenderMaleSole ProprietorYesEnumeration Date12/22/2016Last Updated12/22/2016Contact InformationPractice LocationPractice Address14392 91st Pl N, Maple Grove, MN 55369-8530Phone(605) 393-7169FaxUnlisted FaxMailing LocationMailing Address14392 91st Pl N, Maple Grove, MN 55369-8530Phone(605) 393-7169FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense10189Minnesota