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NPI Code Detail

MEDICARE: BENJAMIN PORTER

MEDICARE:   BENJAMIN  PORTER
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
1225100000XPhysical Therapist2560ND
2225100000XPhysical Therapist21835MT

General Provider Information

NPI Number : 1801568514
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN PORTER
Provider Business Mailing Address
First Line : 850 HOLT DR
Second Line :
City : BIGFORK
State : MT
Zip : 59911-6218
Country : US
Telephone Number : 406-837-3255
Fax Number :
Provider Business Practice Location Address
First Line : 850 HOLT DR
Second Line :
City : BIGFORK
State : MT
Zip : 59911-6218
Country : US
Telephone Number : 406-837-3255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2021
Last Update Date : 09/30/2021

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Directions to “ BENJAMIN PORTER ” Practice Location

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