Provider Demographics
NPI:1225440753
Name:GARDINER, ALLISON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GARDINER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 EVERGREEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1979
Mailing Address - Country:US
Mailing Address - Phone:215-450-8978
Mailing Address - Fax:
Practice Address - Street 1:2410 EVERGREEN RD STE 100
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1979
Practice Address - Country:US
Practice Address - Phone:215-450-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260023402255A2300X
MDA00013072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer