Provider Demographics
NPI:1316042955
Name:BENTZ PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:BENTZ PHYSICAL THERAPY, PC
Other - Org Name:BENTZ PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:BLACKWELL
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-338-4220
Mailing Address - Street 1:800 HEMPHILL ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3107
Mailing Address - Country:US
Mailing Address - Phone:817-338-4220
Mailing Address - Fax:817-338-1639
Practice Address - Street 1:800 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3107
Practice Address - Country:US
Practice Address - Phone:817-338-4220
Practice Address - Fax:817-338-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601630000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00105ZMedicare PIN