Provider Demographics
NPI:1548224140
Name:GENTZLER, TODD L (PT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:L
Last Name:GENTZLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 S MARKET BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-4100
Mailing Address - Country:US
Mailing Address - Phone:360-996-4410
Mailing Address - Fax:360-996-4466
Practice Address - Street 1:1817 S MARKET BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4100
Practice Address - Country:US
Practice Address - Phone:360-996-4410
Practice Address - Fax:360-996-4466
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60770270225100000X
WYPT-491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308415Medicare ID - Type Unspecified