Active NPI
Tyler Bentrup
- Physical Therapist
- Evans, GA
National Provider Identifier
1316540305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 415 Town Park Blvd
Evans, GA 30809-3487 - Phone
- (706) 868-1707
- NPI assigned
- Nov 20, 2020
- Last updated
- Nov 20, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | Primary |
Addresses
Primary practice location
415 Town Park Blvd
Evans, GA 30809-3487
Mailing address
111 17TH Ave E
Alexandria, MN 56308-5273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700438400000",
"number": "1316540305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 17TH AVE E",
"city": "ALEXANDRIA",
"state": "MN",
"postal_code": "563085273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 TOWN PARK BLVD",
"city": "EVANS",
"state": "GA",
"postal_code": "308093487",
"telephone_number": "706-868-1707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENTRUP",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-20",
"last_updated": "2023-11-20",
"certification_date": "2023-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
- Birhanu Bedaso
- Belair Dental Associates
- Mark Allan Benak, M.D.
- Debbie Benoit-Harris, MD
- Karyl Yardena Bental, D.O.
- Nancy Gunn Berryhill, CCC-SLP
- Beth Anne Flack DC PC (Flack Family Chiropractic)
- Beth Anne Flack DC PC (Flack Family Chiropractic)
- Better Behavior, Better Families LLC
- Better Days Therapies of Augusta
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.