Provider Demographics
NPI:1811189848
Name:GARDINER-SHIRES, ALISON MARIE (PHD, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARIE
Last Name:GARDINER-SHIRES
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 S. NEW ST. SURZEBECKER HSC OFFICE 305
Mailing Address - Street 2:WCU
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19383
Mailing Address - Country:US
Mailing Address - Phone:610-436-2515
Mailing Address - Fax:610-436-2803
Practice Address - Street 1:WCU
Practice Address - Street 2:855 S. NEW ST. SURZEBECKER HSC OFFICE 305
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19383-0001
Practice Address - Country:US
Practice Address - Phone:610-436-2515
Practice Address - Fax:610-436-2803
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0032722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer