Provider Demographics
NPI:1982699278
Name:BENTLEY, JULIA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:A
Last Name:BENTLEY
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 1:149 MEDICAL PLAZA LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858
Mailing Address - Country:US
Mailing Address - Phone:606-632-1188
Mailing Address - Fax:606-632-0075
Practice Address - Street 1:149 MEDICAL PLAZA LANE
Practice Address - Street 2:SUITE A
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858
Practice Address - Country:US
Practice Address - Phone:606-632-1188
Practice Address - Fax:606-632-0075
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0572902Medicare ID - Type Unspecified
R40385Medicare UPIN