MEDICARE: MRS. TAMMY RENAY GENTRY MPT

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
1	225100000X	Physical Therapist	1135929	TX

General Provider Information

NPI Number	:	1457489171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY RENAY GENTRY MPT

Provider Business Mailing Address
First Line	:	151 FM 610
Second Line	:
City	:	ASPERMONT
State	:	TX
Zip	:	79502-2302
Country	:	US
Telephone Number	:	940-988-4216
Fax Number	:	940-988-4217

Provider Business Practice Location Address
First Line	:	821 N BROADWAY ST
Second Line	:
City	:	ASPERMONT
State	:	TX
Zip	:	79502-2029
Country	:	US
Telephone Number	:	940-989-3551
Fax Number	:	940-989-3395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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