Active NPI
Grayson Gentzel, PT, D.P.T.
- Geriatric Physical Therapist
- Dacula, GA
National Provider Identifier
1477557155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- PT004112
- Practice address
- 2078 Teron Trce
Suite 250
Dacula, GA 30019-1604 - Phone
- (404) 993-9082
- Fax
- (866) 571-5808
- NPI assigned
- Jun 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | PT004112 | GA | Primary |
Addresses
Primary practice location
2078 Teron Trce
Suite 250
Dacula, GA 30019-1604
Mailing address
2078 Teron Trce
Suite 250
Dacula, GA 30019-1604
Phone (404) 993-9082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT004112 | GA | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293667200000",
"number": "1477557155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2078 TERON TRCE",
"address_2": "SUITE 250",
"city": "DACULA",
"state": "GA",
"postal_code": "300191604",
"telephone_number": "404-993-9082",
"fax_number": "866-571-5808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2078 TERON TRCE",
"address_2": "SUITE 250",
"city": "DACULA",
"state": "GA",
"postal_code": "300191604",
"telephone_number": "404-993-9082",
"fax_number": "866-571-5808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTZEL",
"first_name": "GRAYSON",
"name_prefix": "Dr.",
"credential": "PT, D.P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-09",
"last_updated": "2010-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "GA",
"license": "PT004112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.