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General NPI Number Information
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NPI Number | 1235412636
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Entity Type | Individual
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Provider Name | JENNIFER LYNN BENTLEY DPT, OCS
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Gender | Female
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 5541 W 13400 S
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City | HERRIMAN
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State | UT
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Zip | 84096-5640
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Country | US
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Telephone | 801-871-4771
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Fax | 801-871-4771
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Provider Business Mailing Address
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Address Line | 15132 S WALNUT GROVE DR
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City | DRAPER
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State | UT
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Zip | 84020-5539
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Country | US
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Telephone | 801-831-5202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8064759-2401
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License Number State | UT
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