Provider Demographics
NPI:1053821959
Name:BENNETT, MADISON JUNE (PT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:JUNE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:JUNE
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:510 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-4637
Mailing Address - Country:US
Mailing Address - Phone:605-515-0539
Mailing Address - Fax:
Practice Address - Street 1:510 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-4600
Practice Address - Country:US
Practice Address - Phone:701-748-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer