Healthcare Provider Details

I. General information

NPI: 1417616061
Provider Name (Legal Business Name): BRANDY TERESE WEBER BENTLEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 E ILIFF AVE
DENVER CO
80231-3462
US

IV. Provider business mailing address

1270 S LINCOLN ST
DENVER CO
80210-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-636-5600
  • Fax:
Mailing address:
  • Phone: 303-564-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0009093
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: