Individual
JEFFREY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
533 S MIDDLETON RD, STE 100, MIDDLETON, ID 83644-6013
(208) 585-6566
(208) 585-6768
Mailing address
7550 W EMERALD ST, BOISE, ID 83704-9015
(208) 375-0666
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4080
ID
Other
Enumeration date
04/08/2015
Last updated
04/08/2015
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