Healthcare Provider Details

I. General information

NPI: 1447184148
Provider Name (Legal Business Name): CEANNA BENNER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

18562 EMERALD LAKE AVE
NAMPA ID
83687-5700
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-4444
  • Fax:
Mailing address:
  • Phone: 208-936-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7481410
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: