Provider Demographics
NPI:1457489171
Name:GENTRY, TAMMY RENAY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:RENAY
Last Name:GENTRY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FM 610
Mailing Address - Street 2:
Mailing Address - City:ASPERMONT
Mailing Address - State:TX
Mailing Address - Zip Code:79502-2302
Mailing Address - Country:US
Mailing Address - Phone:940-988-4216
Mailing Address - Fax:940-988-4217
Practice Address - Street 1:821 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASPERMONT
Practice Address - State:TX
Practice Address - Zip Code:79502-2029
Practice Address - Country:US
Practice Address - Phone:940-989-3551
Practice Address - Fax:940-989-3395
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist