Provider Demographics
NPI:1811533730
Name:GENTHNER, BRIANNA LESLIE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LESLIE
Last Name:GENTHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 EGYPT RD
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4306
Mailing Address - Country:US
Mailing Address - Phone:207-380-4629
Mailing Address - Fax:
Practice Address - Street 1:389 EGYPT RD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4306
Practice Address - Country:US
Practice Address - Phone:207-380-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer