MEDICARE: ALEXIS GENTRY

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	225700000X	Massage Therapist	3084	CA

General Provider Information

NPI Number	:	1306789599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS GENTRY

Provider Business Mailing Address
First Line	:	1917 DARTMOOR DR
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-3426
Country	:	US
Telephone Number	:	619-800-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 DARTMOOR DR
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-3426
Country	:	US
Telephone Number	:	619-800-9210
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ ALEXIS GENTRY ” Practice Location

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