Provider Demographics
NPI:1861582637
Name:BENCHMARK PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:BENCHMARK PHYSICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-632-5800
Mailing Address - Street 1:4964 BENCHMARK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2028
Mailing Address - Country:US
Mailing Address - Phone:618-632-5800
Mailing Address - Fax:618-632-5855
Practice Address - Street 1:4964 BENCHMARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2028
Practice Address - Country:US
Practice Address - Phone:618-632-5800
Practice Address - Fax:618-632-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8232149OtherBCBSIL
IL212353Medicare PIN