Individual provider · NPI-1

Bryan Bengston

Physical Medicine & Rehabilitation, Sports Medicine · Saint Louis, MO

NPI number1073166864
StatusActive
Last updated in NPPESJul 20, 2019

Details

NPI
1073166864
Entity type
Individual (NPI-1)
Name
Bryan Bengston
Sex
Male
Sole proprietor
Yes
Enumeration date
Jul 20, 2019
Last updated
Jul 20, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine2009005829MOYes

Practice location

624 Sessions Ave
Saint Louis, MO 63126-1030

Phone 314-974-0416

Mailing address

624 Sessions Ave
Saint Louis, MO 63126-1030

Phone 314-974-0416

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