Provider Demographics
NPI:1750438529
Name:BENTLEY, BRADFORD (DPT)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:808 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3707
Mailing Address - Country:US
Mailing Address - Phone:206-444-6320
Mailing Address - Fax:206-444-6302
Practice Address - Street 1:15623 1ST AVE S STE C
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1292
Practice Address - Country:US
Practice Address - Phone:206-444-6320
Practice Address - Fax:206-444-6302
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8865497OtherMEDICARE (GROUP #)
WA0142606OtherDEPT OF L&I
WA5411BEOtherREGENCE BLUE
WA912117273OtherTAX ID
WA1598725798OtherNPI GROUP NUMBER
WA7104300Medicaid
WA5122997OtherCIGNA
WA8865765OtherMEDICARE -NEW IND. NUMBER
WA0142606OtherDEPT OF L&I