Provider Demographics
NPI:1821012295
Name:GARDNER, PAUL JEFFREY (MS ATC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JEFFREY
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:JEFFREY
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5903 CHOCKCHERRY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4408
Mailing Address - Country:US
Mailing Address - Phone:719-262-9976
Mailing Address - Fax:719-234-2399
Practice Address - Street 1:8720 SCARBOROUGH DR
Practice Address - Street 2:LIBERTY HIGH SCHOOL
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-234-2252
Practice Address - Fax:719-234-2399
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer