Healthcare Provider Details

I. General information

NPI: 1538472121
Provider Name (Legal Business Name): KIMBERLY ANNE BENTLEY PT, DPT, IDN CERT.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 TIMBERVIEW LN
ANNISTON AL
36207-8625
US

IV. Provider business mailing address

731 LEIGHTON AVE
ANNISTON AL
36207-5761
US

V. Phone/Fax

Practice location:
  • Phone: 334-312-4663
  • Fax:
Mailing address:
  • Phone: 256-235-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5300
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: