# GENTIVA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** mid-south
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477670081
- **Authorized official:** MR. JACK ANTHONY ELLIS JR. MS, PT, CMT (PHYSICAL THERAPIST)
- **Authorized official phone:** (205) 914-8588

## Contact information

- **Practice address:** 2200 RIVERCHASE CTR STE 700, BIRMINGHAM, AL 35244-2915
- **Practice address phone:** (205) 739-7800
- **Mailing address:** 2034 FOREST LAKES LN, STERRETT, AL 35147-8151
- **Mailing address phone:** (205) 914-8588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PTH4693 | AL | Yes |

## Other

- **Enumeration date:** 03/26/2007
- **Last updated:** 08/22/2020