Basic Information
| Provider Information | |||||||||
| NPI: | 1649401035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENTHE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | CATHRYN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THACKERY-GENTHE | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | CATHRYN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.S.P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6016 LOVERS LN | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490023050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693290934 | ||||||||
| FaxNumber: | 2693290965 | ||||||||
| Practice Location | |||||||||
| Address1: | 6016 LOVERS LN | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490023050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693290934 | ||||||||
| FaxNumber: | 2693290965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2009 | ||||||||
| LastUpdateDate: | 08/03/2009 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501010103 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.