Provider Demographics
NPI:1134733025
Name:GARDNER, HANNAH MARIE (ATC, BA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:ATC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 CORAL CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2812
Mailing Address - Country:US
Mailing Address - Phone:319-721-3722
Mailing Address - Fax:
Practice Address - Street 1:2894 CORAL CT
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2812
Practice Address - Country:US
Practice Address - Phone:319-721-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer