Provider Demographics
NPI:1841641354
Name:GEBREMESKEL, SENTAYEHU I (PT)
Entity type:Individual
Prefix:
First Name:SENTAYEHU
Middle Name:
Last Name:GEBREMESKEL
Suffix:I
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 EXPOSITION WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6094
Mailing Address - Country:US
Mailing Address - Phone:817-798-0086
Mailing Address - Fax:
Practice Address - Street 1:4709 EXPOSITION WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6094
Practice Address - Country:US
Practice Address - Phone:817-798-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119493251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based