Provider Demographics
NPI:1144533233
Name:GENTRY, TESSA SHOE (PT)
Entity type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:SHOE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 GENTRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-8292
Mailing Address - Country:US
Mailing Address - Phone:336-503-3440
Mailing Address - Fax:
Practice Address - Street 1:1169 GENTRY RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27574-8292
Practice Address - Country:US
Practice Address - Phone:336-503-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist