Provider Demographics
NPI:1225316904
Name:GENTRY, MEGAN DANIELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DANIELLE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 557 BOX 793
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-0008
Mailing Address - Country:US
Mailing Address - Phone:864-630-1722
Mailing Address - Fax:
Practice Address - Street 1:2360 KINSTON HWY
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-6271
Practice Address - Country:US
Practice Address - Phone:910-389-6749
Practice Address - Fax:910-324-4325
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist