Provider Demographics
NPI:1396997722
Name:GENTRY, LYNWOOD OVERTON JR (PHD OTR/L)
Entity type:Individual
Prefix:DR
First Name:LYNWOOD
Middle Name:OVERTON
Last Name:GENTRY
Suffix:JR
Gender:M
Credentials:PHD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 SUNVIEW LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4150
Mailing Address - Country:US
Mailing Address - Phone:804-267-1947
Mailing Address - Fax:
Practice Address - Street 1:8520 SUNVIEW LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4150
Practice Address - Country:US
Practice Address - Phone:804-267-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001845171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor