MEDICARE: BEN BODILY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3671499	ID

General Provider Information

NPI Number	:	1609729672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN BODILY PT

Provider Business Mailing Address
First Line	:	2720 ROSS AVE
Second Line	:
City	:	AMMON
State	:	ID
Zip	:	83406-7815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2277 E LINCOLN RD
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-2202
Country	:	US
Telephone Number	:	208-701-1800
Fax Number	:	208-534-7002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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Directions to “ BEN BODILY PT” Practice Location

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