Provider Demographics
NPI:1114325040
Name:GARDINER, BRAD
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:GARDINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 BRINTON CIR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-8155
Mailing Address - Country:US
Mailing Address - Phone:801-814-9785
Mailing Address - Fax:
Practice Address - Street 1:2833 BRINTON CIR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-8155
Practice Address - Country:US
Practice Address - Phone:801-814-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer