Provider Demographics
NPI:1144842980
Name:BENTLEY, BRANDI (RT (R) (CT))
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RT (R) (CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 CAMILLIA BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3009
Mailing Address - Country:US
Mailing Address - Phone:512-585-8495
Mailing Address - Fax:
Practice Address - Street 1:10605 CAMILLIA BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3009
Practice Address - Country:US
Practice Address - Phone:512-585-8495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGMR000241112471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography