Provider Demographics
NPI:1801953336
Name:BENTLEY, THOMAS JAMES (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:BENTLEY
Suffix:
Gender:M
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:OR
Mailing Address - Zip Code:97633-0303
Mailing Address - Country:US
Mailing Address - Phone:541-880-3586
Mailing Address - Fax:877-552-1302
Practice Address - Street 1:415 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MERRILL
Practice Address - State:OR
Practice Address - Zip Code:97633
Practice Address - Country:US
Practice Address - Phone:541-880-3586
Practice Address - Fax:877-552-1302
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
007334005OtherBLUE CROSS
A008OtherTRICARE
OR228855Medicaid