=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346898913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENTRY ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2019
-----------------------------------------------------
Last Update Date | 08/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 5TH AVE S
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-4612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-463-0550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1912 SHAYLIN LOOP
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37013-8405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-463-0550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. ROSS GENTRY
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 901-463-0550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------