Provider Demographics
NPI:1801029319
Name:GENTRY, GINGER ANN (LMT)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:ANN
Last Name:GENTRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 VANNEST AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2660
Mailing Address - Country:US
Mailing Address - Phone:513-465-1167
Mailing Address - Fax:513-539-2822
Practice Address - Street 1:5900 LONG MEADOW DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-9687
Practice Address - Country:US
Practice Address - Phone:513-420-3773
Practice Address - Fax:513-420-3795
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14441172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist