Provider Demographics
NPI:1881430726
Name:GENTILE, MICHAEL A (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:GENTILE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 UPPER GULPH RD
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2412
Mailing Address - Country:US
Mailing Address - Phone:484-431-4097
Mailing Address - Fax:
Practice Address - Street 1:1200 CONSTITUTION AVE STE 110
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1323
Practice Address - Country:US
Practice Address - Phone:888-393-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist