Provider Demographics
NPI:1144532631
Name:BENTLEY, JAIME L (PT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7267
Mailing Address - Country:US
Mailing Address - Phone:419-621-0035
Mailing Address - Fax:419-621-9768
Practice Address - Street 1:1401 BONE CREEK DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7267
Practice Address - Country:US
Practice Address - Phone:419-621-0035
Practice Address - Fax:419-621-9768
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 012888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist