Provider Demographics
NPI:1720105554
Name:BENTLEY, MARYANN
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:SOUTHEASTERN
Mailing Address - State:PA
Mailing Address - Zip Code:19399-0064
Mailing Address - Country:US
Mailing Address - Phone:610-296-2527
Mailing Address - Fax:610-296-2790
Practice Address - Street 1:600 PAOLI POINTE DR
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-2104
Practice Address - Country:US
Practice Address - Phone:610-296-2527
Practice Address - Fax:610-296-2790
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007011L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist