Provider Demographics
NPI:1841681194
Name:BENTLEY, KYLA DANIELLE (DPT)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:DANIELLE
Last Name:BENTLEY
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-1940
Mailing Address - Country:US
Mailing Address - Phone:319-283-2002
Mailing Address - Fax:319-283-2015
Practice Address - Street 1:204 E CHARLES ST
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1940
Practice Address - Country:US
Practice Address - Phone:319-283-2002
Practice Address - Fax:319-283-2015
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01481870OtherRR MEDICARE PIN
IA1841681194Medicaid
IAP01481870OtherRR MEDICARE PIN