Provider Demographics
NPI:1649401035
Name:GENTHE, AMY CATHRYN (MSPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CATHRYN
Last Name:GENTHE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CATHRYN
Other - Last Name:THACKERY-GENTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:6016 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3050
Mailing Address - Country:US
Mailing Address - Phone:269-329-0934
Mailing Address - Fax:269-329-0965
Practice Address - Street 1:6016 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3050
Practice Address - Country:US
Practice Address - Phone:269-329-0934
Practice Address - Fax:269-329-0965
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist