Provider Demographics
NPI:1225614837
Name:GARDNER, AUSTIN JOHN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JOHN
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 1:981 HIGH HOUSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3510
Mailing Address - Country:US
Mailing Address - Phone:193-880-1119
Mailing Address - Fax:919-388-8668
Practice Address - Street 1:3150 ROGERS RD STE 216
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7068
Practice Address - Country:US
Practice Address - Phone:919-229-8363
Practice Address - Fax:919-229-8356
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029176225100000X
NCP21101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist