Healthcare Provider Details

I. General information

NPI: 1194840413
Provider Name (Legal Business Name): LEA A GENTLE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEA A SNYDER

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LEE RD
FOLLANSBEE WV
26037-1783
US

IV. Provider business mailing address

542 FORESTVIEW DR
WINTERSVILLE OH
43953-9055
US

V. Phone/Fax

Practice location:
  • Phone: 304-527-1100
  • Fax: 304-527-0909
Mailing address:
  • Phone: 740-266-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6918
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001319
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: