Provider Demographics
NPI:1306028097
Name:BENTLEY, TIFFINEY SHAWN (PT,MS)
Entity Type:Individual
Prefix:MS
First Name:TIFFINEY
Middle Name:SHAWN
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3601
Mailing Address - Country:US
Mailing Address - Phone:304-235-9781
Mailing Address - Fax:304-235-9782
Practice Address - Street 1:38 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3500
Practice Address - Country:US
Practice Address - Phone:304-235-9781
Practice Address - Fax:304-235-9782
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004678225100000X
WV002748225100000X
WVPT002748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist