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Organization

GENTRY MARTIAL ARTS

Active
Other names
GMAM
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BRANDON SIEG (PRESIDENT)
(765) 342-5600
Entity
Organization

Contact information

Practice address
333 W. WASHIGTON ST., MARTINSVILLE, IN 46151-1431
(765) 342-5600
(765) 342-5605
Mailing address
PO BOX 1414, MARTINSVILLE, IN 46151-0414
(765) 342-5600
(765) 342-5605

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200918350 A
IN
Enumeration date
01/23/2009
Last updated
01/23/2009
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