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NPI Code Detail

MEDICARE: MAUREEN ELIZABETH GENTRY D.P.T.

MEDICARE: MAUREEN ELIZABETH GENTRY D.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
1225100000XPhysical Therapist.8324SC

General Provider Information

NPI Number : 1578002630
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAUREEN ELIZABETH GENTRY D.P.T.
Provider Business Mailing Address
First Line : 2358 FREEDOM BLVD APT B2
Second Line :
City : FLORENCE
State : SC
Zip : 29505-6180
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 56 GENESIS DR
Second Line :
City : LAKE CITY
State : SC
Zip : 29560-5531
Country : US
Telephone Number : 843-389-3685
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2017
Last Update Date : 02/21/2017

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