Benjamin Blakely, PT, DPT
Individual provider Active NPI Physical Therapist · Missoula, MT
NPI 1306579347 · NPPES record last updated Jul 7, 2022
Key facts
- NPI
- 1306579347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 24307 (MT)
- Practice address
- 1705 Bow St
Missoula, MT 59801-5652 - Phone
- (406) 549-5283
- NPI assigned
- Jul 7, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sapphire Physical Therapy PC
Practice addresses (Care Compare)
1705 Bow St
Missoula, MT 59801-5652
Phone (406) 549-5283
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230327002258 | MT | Practitioner - Physical Therapist in Private Practice | 2961876370 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24307 | MT | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sapphire Physical Therapy, PC | Current |
Accepting new patients |
Locations
1705 Bow St
Missoula, MT 59801
Phone (406) 219-1407
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 24307 | MT | Yes |
Addresses
Primary practice location
1705 Bow St
Missoula, MT 59801-5652
Mailing address
600 Evans Ave
Missoula, MT 59801-5824
Other providers in Missoula, MT
- Jacob Blackwell
- Kaylee Virginia Blackwell
- Katherine Blaedow
- Donald Robert Blair
- Jolynn Marie Blakeley
- Kimberly Blakeslee
- Tonya Blaney
- Brandon Blank
- Natalie Blauer
- Blair Bliss
All providers in Missoula, MT · Physical Therapist in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.