Provider Demographics
NPI:1164640082
Name:GARDNER, LAURINDA (CMT)
Entity Type:Individual
Prefix:
First Name:LAURINDA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 FAR VW
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6282
Mailing Address - Country:US
Mailing Address - Phone:720-988-5185
Mailing Address - Fax:
Practice Address - Street 1:634 KIMBARK ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8300
Practice Address - Country:US
Practice Address - Phone:720-988-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist