Provider Demographics
NPI:1659328656
Name:GARDNER, CHARLES CHESLEY (MS, RKT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHESLEY
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MS, RKT
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Mailing Address - Street 1:2220 SWANHURST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-9649
Mailing Address - Country:US
Mailing Address - Phone:804-897-3771
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:KT/PM&R/117
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5325
Practice Address - Fax:804-675-5857
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist