Provider Demographics
NPI:1437675576
Name:ENSIGN, GENTRY BRUCE (DPT)
Entity Type:Individual
Prefix:
First Name:GENTRY
Middle Name:BRUCE
Last Name:ENSIGN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 BURDEN BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5633
Mailing Address - Country:US
Mailing Address - Phone:509-416-0444
Mailing Address - Fax:509-545-1112
Practice Address - Street 1:4303 W 24TH AVE STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1963
Practice Address - Country:US
Practice Address - Phone:509-416-0444
Practice Address - Fax:509-545-1112
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60736003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist