Provider Demographics
NPI:1003265695
Name:GARDNER, BETHANY ELAINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ELAINE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ELAINE
Other - Last Name:CARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3615 W STAG DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-7901
Mailing Address - Country:US
Mailing Address - Phone:814-553-4947
Mailing Address - Fax:
Practice Address - Street 1:5770 BAUM BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3763
Practice Address - Country:US
Practice Address - Phone:412-661-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.11938225100000X
PAPT029993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist