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General NPI Number Information
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NPI Number | 1235855545
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Entity Type | Individual
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Provider Name | JUDY GRAY BENTLEY LMT
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Gender | Female
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 178 SW RANGE AVE
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City | MADISON
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State | FL
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Zip | 32340-2458
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Country | US
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Telephone | 185-097-3899
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Fax |
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Provider Business Mailing Address
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Address Line | 8404 N STATE ROAD 53
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City | MADISON
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State | FL
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Zip | 32340-3536
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Country | US
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Telephone | 850-673-8070
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA99225
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License Number State | FL
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