Provider Demographics
NPI:1558577916
Name:GARDNER, CAITLIN ANNICE (MPT)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:ANNICE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ANNICE
Other - Last Name:MCGURK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:100 S FIRST STREET
Practice Address - Street 2:STE B
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1501
Practice Address - Country:US
Practice Address - Phone:717-692-4708
Practice Address - Fax:717-692-5464
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007513L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035884240003Medicaid
PA808916OtherMEDICARE