Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 10196389-2401 | UT |
NPI | 1053856229 |
---|---|
Provider Name | Bradford Scott Bentley JR. |
First Address | Riverton, UT 84065 |
Second Address | Riverton, UT 84065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2016 |
Last Update Date | 27/12/2016 |