Provider Demographics
NPI:1346716461
Name:BENTZ, ANNA LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUISE
Last Name:BENTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-3905
Mailing Address - Country:US
Mailing Address - Phone:504-432-8316
Mailing Address - Fax:
Practice Address - Street 1:223 BAY OAKS DR
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-3905
Practice Address - Country:US
Practice Address - Phone:504-432-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist