Provider Demographics
NPI:1013467356
Name:GARDNER, JULIE ALLISON (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ALLISON
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7481 HIGHWAY 65 69
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-9613
Mailing Address - Country:US
Mailing Address - Phone:515-953-1300
Mailing Address - Fax:515-953-2139
Practice Address - Street 1:7481 HIGHWAY 65 69
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-9613
Practice Address - Country:US
Practice Address - Phone:515-953-1300
Practice Address - Fax:515-953-2139
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist