Provider Demographics
NPI:1235855545
Name:BENTLEY, JUDY GRAY (LMT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:GRAY
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 N STATE ROAD 53
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-3536
Mailing Address - Country:US
Mailing Address - Phone:850-673-8070
Mailing Address - Fax:
Practice Address - Street 1:178 SW RANGE AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2458
Practice Address - Country:US
Practice Address - Phone:185-097-3899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist