Provider Demographics
NPI:1851335384
Name:GARDINER, DEBORAH P (PT, ATC, CHT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:P
Last Name:GARDINER
Suffix:
Gender:F
Credentials:PT, ATC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2868
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0259
Mailing Address - Country:US
Mailing Address - Phone:518-562-4616
Mailing Address - Fax:518-562-7918
Practice Address - Street 1:214 CORNELIA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2317
Practice Address - Country:US
Practice Address - Phone:518-314-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003967225100000X, 2251H1200X
NY010142-1225100000X, 2251H1200X
NY002607-12255A2300X
CT0002992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004132015Medicaid