Individual
JACQUELINE GENTILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD STE 774, PORT ORANGE, FL 32128-8321
(888) 265-2680
Mailing address
6 CAREY AVE, CARBONDALE, PA 18407-2520
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
0563
SD
225200000X
Physical Therapy Assistant
09713
OR
225200000X
Physical Therapy Assistant
Primary
9634
MA
225200000X
Physical Therapy Assistant
TE011682
PA
Other
Enumeration date
05/29/2019
Last updated
06/11/2019
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