Provider Demographics
NPI:1831352756
Name:BOLAND, GENTRY WEBB (PTA)
Entity type:Individual
Prefix:MR
First Name:GENTRY
Middle Name:WEBB
Last Name:BOLAND
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6405 METCALF AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202
Mailing Address - Country:US
Mailing Address - Phone:913-831-2721
Mailing Address - Fax:913-384-0513
Practice Address - Street 1:6405 METCALF AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202
Practice Address - Country:US
Practice Address - Phone:913-831-2721
Practice Address - Fax:913-384-0513
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST02047225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant