Individual
CARLY GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1150 PONCE DE LEON BLVD, CLEARWATER, FL 33756
(727) 584-5893
Mailing address
1996 KINGS GATE LN, MOUNT PLEASANT, SC 29466
(727) 543-4881
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
25517
FL
225200000X
Physical Therapy Assistant
Primary
4269
SC
Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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