Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1083386304 |
---|---|
Provider Name | Gentry Lewis |
First Address | Richmond, KY 40475-2774 |
Second Address | Richmond, KY 40475-2774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2021 |
Last Update Date | 14/12/2021 |