Provider Demographics
NPI:1013987460
Name:BENNETT, MARK JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 YUHAS AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 COLONIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4902
Practice Address - Country:US
Practice Address - Phone:406-449-4279
Practice Address - Fax:406-449-8043
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1720PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0173627OtherWAWC
MT3400124Medicaid
MSF1224544OtherMT STATE FUND
MT841391220014OtherEBMS
P00043272OtherRR MEDICARE