Provider Demographics
NPI:1225192974
Name:THIRY, GARY D (PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:THIRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0453
Mailing Address - Country:US
Mailing Address - Phone:828-693-8128
Mailing Address - Fax:828-639-0955
Practice Address - Street 1:1635 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2305
Practice Address - Country:US
Practice Address - Phone:828-693-8128
Practice Address - Fax:828-693-0955
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC720793HMedicaid
NC2501446AMedicare ID - Type Unspecified