Individual
MR. JACK BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
67 E MIDTOWN PARK, MOBILE, AL 36606-4141
(251) 476-1279
(251) 476-2882
Mailing address
5757 DEERWOOD DR S, MOBILE, AL 36618-3004
(251) 344-8463
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTH3594
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTH3594
PHYSICAL THERAPY LICENSE
AL
Enumeration date
09/29/2006
Last updated
07/08/2007
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