Provider Demographics
NPI:1386864270
Name:GENTES, GWEN M (PTA)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:M
Last Name:GENTES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 61ST AVE SE APT A
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-5124
Mailing Address - Country:US
Mailing Address - Phone:608-769-9778
Mailing Address - Fax:
Practice Address - Street 1:BALLINGER REHABILITATION AND THERAPY
Practice Address - Street 2:6007 B 244TH ST SW
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043
Practice Address - Country:US
Practice Address - Phone:425-640-4762
Practice Address - Fax:425-640-4885
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI308-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant