Provider Demographics
NPI:1033659990
Name:GARTNER, RANDI (DPT)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:GARTNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 HOOPER AVE
Mailing Address - Street 2:1
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6238
Mailing Address - Country:US
Mailing Address - Phone:732-840-3658
Mailing Address - Fax:
Practice Address - Street 1:2557 HOOPER AVE
Practice Address - Street 2:1
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6238
Practice Address - Country:US
Practice Address - Phone:732-840-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01138900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist