Individual
JOSEPH BENTIVOGLIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
6 BRINTON AVE, MEDIA, PA 19063-4810
(484) 574-6005
Mailing address
6 BRINTON AVENUE, MEDIA, PA 19063
(484) 574-6005
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT005612
PA
Other
Enumeration date
12/09/2013
Last updated
12/09/2013
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