Provider Demographics
NPI:1942330352
Name:GARDNER KELLY REHABILITATION
Entity Type:Organization
Organization Name:GARDNER KELLY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPY
Authorized Official - Phone:801-255-4999
Mailing Address - Street 1:9350 S 150 E # 460
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2702
Mailing Address - Country:US
Mailing Address - Phone:801-255-4999
Mailing Address - Fax:801-748-1865
Practice Address - Street 1:9350 S 150 E # 460
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2702
Practice Address - Country:US
Practice Address - Phone:801-255-4999
Practice Address - Fax:801-748-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty