MEDICARE: DR. AUSTIN ALLEN GENTRY JR. D.C., P.T.

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	111N00000X	Chiropractor	4198	AZ
2	225100000X	Physical Therapist	449	AZ

General Provider Information

NPI Number	:	1568429413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN ALLEN GENTRY JR. D.C., P.T.

Provider Business Mailing Address
First Line	:	899 N WILMOT RD
Second Line	:	SUITE A-3
City	:	TUCSON
State	:	AZ
Zip	:	85711-1714
Country	:	US
Telephone Number	:	520-745-0545
Fax Number	:	520-745-0505

Provider Business Practice Location Address
First Line	:	899 N WILMOT RD
Second Line	:	SUITE A-3
City	:	TUCSON
State	:	AZ
Zip	:	85711-1714
Country	:	US
Telephone Number	:	520-745-0545
Fax Number	:	520-745-0505

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	12/15/2010

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