Benjamin Porter
Individual provider Active NPI Physical Therapist · Bigfork, MT
NPI 1801568514 · NPPES record last updated Sep 30, 2021
Key facts
- NPI
- 1801568514
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 21835 (MT)
- Practice address
- 850 Holt Dr
Bigfork, MT 59911-6218 - Phone
- (406) 837-3255
- NPI assigned
- Sep 30, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lighthouse Physical Therapy and Sports Medicine
Practice addresses (Care Compare)
18915 E Appleway Ave
Suite A101
Spokane Valley, WA 99016-8856
Phone (509) 928-3443
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241119004695 | WA | Practitioner - Physical Therapist in Private Practice | 8729477732 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21835 | MT | MD | Physical Therapist |
| 2560 | ND | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthouse Physical Therapy and Sports Medicine | Physical Therapist | Current |
Accepting new patients |
| Lighthouse Physical Therapy, LLC | Physical Therapist | Past | Accepting new patients |
Locations
5204 E Broadway Ave
Spokane Valley, WA 99212
18915 E Appleway Ave
Ste A101
Spokane Valley, WA 99016
Phone (509) 723-9999
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2560 | ND | |
| Physical Therapist | 225100000X | 21835 | MT | Yes |
Addresses
Primary practice location
850 Holt Dr
Bigfork, MT 59911-6218
Mailing address
850 Holt Dr
Bigfork, MT 59911-6218
Phone (406) 837-3255
Other providers in Bigfork, MT
- Kaci Lee Monroe
- Montana Mobile Health, Corp
- Kimberly Murray
- Northern Lights Mental Health & Wellness
- Charlotte Dionne Ohara
- Angie Potts
- Erin Carlson Price
- John Matthew Rausch
- Julieanna Genoun Renner
- River Bend Physical Therapy and Preventative Care, LLC
All providers in Bigfork, 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 Sep 30, 2021. 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.