Individual
TYLER GENTRY PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
400 HICKORY ST NW, SUITE 201, ALBANY, OR 97321-1700
(541) 812-5840
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61779
OR
Other
Enumeration date
07/18/2016
Last updated
11/04/2020
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