Provider Demographics
NPI:1558310730
Name:GARDEREWICZ, RENATA (MSPT)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:GARDEREWICZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-3358
Mailing Address - Country:US
Mailing Address - Phone:215-917-6557
Mailing Address - Fax:
Practice Address - Street 1:1932 SAXON DR
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-3358
Practice Address - Country:US
Practice Address - Phone:215-917-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist