Individual
BRIAN MICHAEL GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4201 LAKE BOONE TRAIL, SUITE 4, RALEIGH, NC 27607-7511
(919) 781-4434
(919) 781-5851
Mailing address
4201 LAKE BOONE TRAIL, SUITE 4, RALEIGH, NC 27607-7511
(919) 781-4434
(919) 781-5851
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10092
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079R4
BCBS
NC
01
—
6400040
UNITED HEALTHCARE
—
01
—
7187712
AETNA
—
05
—
7211783
—
NC
05
—
8300041K
—
NC
01
—
E4463
MEDCOST
—
Enumeration date
12/22/2006
Last updated
07/09/2007
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