Provider Demographics
NPI:1477557155
Name:GENTZEL, GRAYSON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:
Last Name:GENTZEL
Suffix:
Gender:M
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 1:2078 TERON TRCE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1604
Mailing Address - Country:US
Mailing Address - Phone:404-993-9082
Mailing Address - Fax:866-571-5808
Practice Address - Street 1:2078 TERON TRCE
Practice Address - Street 2:SUITE 250
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1604
Practice Address - Country:US
Practice Address - Phone:404-993-9082
Practice Address - Fax:866-571-5808
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0041122251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics