Provider Demographics
NPI:1477527141
Name:GARD, KEVIN E (DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:GARD
Suffix:
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:MS 21041
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:215-553-7012
Mailing Address - Fax:215-553-7019
Practice Address - Street 1:1601 CHERRY ST
Practice Address - Street 2:MS 21041
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1320
Practice Address - Country:US
Practice Address - Phone:215-553-7012
Practice Address - Fax:215-553-7019
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007722L225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00184928904OtherAMERICHOICE
NJ231352630OtherHORIZON BC/BS
PA815693OtherBC/BS
PA20035880OtherAMERIHEALTH MERCY
PAP2979020OtherOXFORD
PA001849289Medicaid
PA231352630OtherTRICARE
PA3054832OtherAETNA
PA1140267OtherFIRST HEALTH
PA231352630OtherMULTIPLAN
PA231352630OtherUNITED HEALTHCARE
PAXY4653OtherHEALTH NET
PA231352630OtherUNITED HEALTHCARE