Provider Demographics
NPI:1669625802
Name:GARDNER, DIXIE D
Entity Type:Individual
Prefix:MRS
First Name:DIXIE
Middle Name:D
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 PETTIT RD
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:PA
Mailing Address - Zip Code:15311-1526
Mailing Address - Country:US
Mailing Address - Phone:724-225-5523
Mailing Address - Fax:724-225-0221
Practice Address - Street 1:113 W MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2427
Practice Address - Country:US
Practice Address - Phone:724-941-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001775L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant