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General NPI Number Information
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NPI Number | 1457489171
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Entity Type | Individual
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Provider Name | TAMMY RENAY GENTRY MPT
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 821 N BROADWAY ST
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City | ASPERMONT
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State | TX
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Zip | 79502-2029
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Country | US
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Telephone | 940-989-3551
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Fax | 940-989-3395
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Provider Business Mailing Address
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Address Line | 151 FM 610
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City | ASPERMONT
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State | TX
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Zip | 79502-2302
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Country | US
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Telephone | 940-988-4216
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Fax | 940-988-4217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1135929
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License Number State | TX
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