Individual
MR. MARK JAMES BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2525 COLONIAL DR, SUITE B, HELENA, MT 59601-4902
(406) 449-4279
(406) 449-8043
Mailing address
3845 YUHAS AVE, HELENA, MT 59602-7462
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1720PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0173627
WAWC
MT
05
—
3400124
—
MT
01
—
841391220014
EBMS
MT
01
—
MSF1224544
MT STATE FUND
—
01
—
P00043272
RR MEDICARE
—
Enumeration date
01/26/2006
Last updated
12/27/2007
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