Provider Demographics
NPI:1689004806
Name:GENTRY-YOUNG, PATRICIA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GENTRY-YOUNG
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1228
Mailing Address - Country:US
Mailing Address - Phone:937-324-4301
Mailing Address - Fax:937-324-4305
Practice Address - Street 1:1928 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1228
Practice Address - Country:US
Practice Address - Phone:937-324-4301
Practice Address - Fax:937-324-4305
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6935971744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management