Braden Bennett, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-8106 Issued in ID

Practice address

3100 S Woodruff Ave
Idaho Falls, ID 83404-8310

Phone

(208) 523-8879

NPI assigned

Aug 26, 2022

Last updated

Aug 26, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ellis Physical Therapy and Associates LLC

  • Physical Therapy Clinic/Center
  • Idaho Falls, ID
  • NPI 1821628645

  Physical Therapist

  Medicare reassignment NPD
• Ellis Physical Therapy P a

  • Physical Therapist
  • Idaho Falls, ID
  • NPI 1518203249
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1366161887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5267 BARTON PL",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834065047",
            "telephone_number": "208-705-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048310",
            "telephone_number": "208-523-8879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "BRADEN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-26",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-8106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryant Belnap, PT
• Kylee Belnap, PA-C
• Thomas R. Bench, D.C.
• Benchmark Home Health
• Barry Bennett, MD
• Eric Bennett, M.D.
• Laurren Ashley Bennett, PA-C
• Maialisa Bennett
• Mark Barry Bennett, LMSW
• Ashley Benson, LCSW

• Physical Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.