Healthcare Provider Details

I. General information

NPI: 1053856229
Provider Name (Legal Business Name): BRADFORD SCOTT BENTLEY JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 N MILLER CAMPUS DR
LEHI UT
84048-7233
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 833-577-3422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number10196389-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: