Provider Demographics
NPI:1790073054
Name:GARDNER, HEATHER L (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4974 MOUNTAIN RD
Mailing Address - Street 2:THE SPORTS AND REHAB CLINIC
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4885
Mailing Address - Country:US
Mailing Address - Phone:802-253-5694
Mailing Address - Fax:866-633-6132
Practice Address - Street 1:4974 MOUNTAIN RD
Practice Address - Street 2:THE SPORTS AND REHAB CLINIC
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4885
Practice Address - Country:US
Practice Address - Phone:802-253-5694
Practice Address - Fax:866-633-6132
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0072092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist