Provider Demographics
NPI:1730418997
Name:AUSTIN ALLEN GENTRY PT
Entity type:Organization
Organization Name:AUSTIN ALLEN GENTRY PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-745-0545
Mailing Address - Street 1:899 N WILMOT RD
Mailing Address - Street 2:#A-3
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1714
Mailing Address - Country:US
Mailing Address - Phone:520-745-0545
Mailing Address - Fax:520-745-0505
Practice Address - Street 1:899 N WILMOT RD
Practice Address - Street 2:#A-3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1714
Practice Address - Country:US
Practice Address - Phone:520-745-0545
Practice Address - Fax:520-745-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ783383721Medicaid