Individual
BRADEN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
3100 S WOODRUFF AVE, IDAHO FALLS, ID 83404-8310
(208) 523-8879
Mailing address
5267 BARTON PL, AMMON, ID 83406-5047
(208) 705-0324
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-8106
ID
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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