Provider Demographics
NPI:1003671090
Name:GARDNER, COLTEN BRYCE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COLTEN
Middle Name:BRYCE
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 WOODWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6160
Mailing Address - Country:US
Mailing Address - Phone:254-224-8062
Mailing Address - Fax:254-224-6385
Practice Address - Street 1:7005 WOODWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6160
Practice Address - Country:US
Practice Address - Phone:254-224-8062
Practice Address - Fax:254-224-6385
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1390169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist