Provider Demographics
NPI:1790974228
Name:GARNICA-GENTRY, ROSA ISABEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ISABEL
Last Name:GARNICA-GENTRY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:ISABEL
Other - Last Name:GARNICA BURGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:RR NO. 2 BOX 208
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441
Mailing Address - Country:US
Mailing Address - Phone:812-847-9675
Mailing Address - Fax:812-847-4708
Practice Address - Street 1:RR NO. 2 BOX 208
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441
Practice Address - Country:US
Practice Address - Phone:812-847-9675
Practice Address - Fax:812-847-4708
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004414A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000194858OtherBLUE CROSS BLUE SHIELD