Basic Information
| Provider Information | |||||||||
| NPI: | 1417406000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENSLINGER | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104446350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7950 LAKE UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328228229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076016888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2016 | ||||||||
| LastUpdateDate: | 09/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 14882 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.