Provider Demographics
NPI:1033431234
Name:BENTRUP, RYAN PAUL
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:BENTRUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 ROUTE 7 S
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8806
Mailing Address - Country:US
Mailing Address - Phone:802-377-2737
Mailing Address - Fax:
Practice Address - Street 1:1641 ROUTE 7 S
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8806
Practice Address - Country:US
Practice Address - Phone:802-377-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist