Provider Demographics
NPI:1326350216
Name:BENTLEY, ERIC JAMES (PTA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12083-0746
Mailing Address - Country:US
Mailing Address - Phone:518-929-6663
Mailing Address - Fax:866-755-5719
Practice Address - Street 1:131 SUNNYSIDE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1539
Practice Address - Country:US
Practice Address - Phone:518-929-6663
Practice Address - Fax:866-755-5719
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007093-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant