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NPI Code Detail

MEDICARE: CHERYL LEE GENTRY PTA

MEDICARE: CHERYL LEE GENTRY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1340SC

General Provider Information

NPI Number : 1215271812
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL LEE GENTRY PTA
Provider Business Mailing Address
First Line : 105 DONEGAL DRIVE
Second Line :
City : AIKEN
State : SC
Zip : 29803
Country : US
Telephone Number : 803-221-1198
Fax Number :
Provider Business Practice Location Address
First Line : 5721 SPRINGFIELD RD
Second Line :
City : WILLISTON
State : SC
Zip : 29853-1917
Country : US
Telephone Number : 803-266-3229
Fax Number : 803-266-2257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2012
Last Update Date : 11/20/2012

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Directions to “ CHERYL LEE GENTRY PTA” Practice Location

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