1750438529 NPI number — BRADFORD BENTLEY DPT

Table of content: BRADFORD BENTLEY DPT (NPI 1750438529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750438529 NPI number — BRADFORD BENTLEY DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENTLEY
Provider First Name:
BRADFORD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENTLEY
Provider Other First Name:
BRAD
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750438529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 3RD AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98109-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-444-6320
Provider Business Mailing Address Fax Number:
206-444-6302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15623 1ST AVE S STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-1292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-444-6320
Provider Business Practice Location Address Fax Number:
206-444-6302
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00007787 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8865497 . This is a "MEDICARE (GROUP #)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0142606 . This is a "DEPT OF L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5411BE . This is a "REGENCE BLUE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 912117273 . This is a "TAX ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1598725798 . This is a "NPI GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7104300 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5122997 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8865765 . This is a "MEDICARE -NEW IND. NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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