Provider Demographics
NPI:1407362841
Name:BENTLEY, JANICE MICHELE (ATC - L)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MICHELE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:ATC - L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N 500 E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1950
Mailing Address - Country:US
Mailing Address - Phone:801-610-8805
Mailing Address - Fax:
Practice Address - Street 1:180 N 500 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1950
Practice Address - Country:US
Practice Address - Phone:801-610-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7142302-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty