Provider Demographics
NPI:1972533461
Name:GARDINER, GARY W (ATC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:W
Last Name:GARDINER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3101 EMRICK BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020
Mailing Address - Country:US
Mailing Address - Phone:610-997-5756
Mailing Address - Fax:610-997-5762
Practice Address - Street 1:3101 EMRICK BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020
Practice Address - Country:US
Practice Address - Phone:610-997-5756
Practice Address - Fax:610-997-5762
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000828B225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist