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General NPI Number Information
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NPI Number | 1861582637
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Entity Type | Organization
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Legal Business Name | BENCHMARK PHYSICAL THERAPY AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 4964 BENCHMARK CENTRE DR
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City | SWANSEA
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State | IL
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Zip | 62226-2028
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Country | US
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Telephone | 618-632-5800
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Fax | 618-632-5855
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Provider Business Mailing Address
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Address Line | 4964 BENCHMARK CENTRE DR
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City | SWANSEA
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State | IL
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Zip | 62226-2028
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Country | US
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Telephone | 618-632-5800
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Fax | 618-632-5855
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Authorized Official
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Title or Position | OWNER
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Name | RICH MUNTAN
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Credential |
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Telephone | 618-632-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070009288
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License Number State | IL
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