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NPI Code Detail

MEDICARE: LUKE G GENTRY PTA

MEDICARE: LUKE G 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 AssistantP160519996WA

General Provider Information

NPI Number : 1295368132
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE G GENTRY PTA
Provider Business Mailing Address
First Line : 1455 NW LEARY WAY STE 150
Second Line :
City : SEATTLE
State : WA
Zip : 98107-5140
Country : US
Telephone Number : 206-782-0218
Fax Number :
Provider Business Practice Location Address
First Line : 1455 NW LEARY WAY STE 150
Second Line :
City : SEATTLE
State : WA
Zip : 98107-5140
Country : US
Telephone Number : 206-782-0218
Fax Number : 206-782-1892
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2020
Last Update Date : 02/19/2020

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Directions to “ LUKE G GENTRY PTA” Practice Location

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