Provider Demographics
NPI:1184918732
Name:GARDNER, BRITTANY (PT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
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 1:35105 KENAI SPUR HWY
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7621
Mailing Address - Country:US
Mailing Address - Phone:907-260-7444
Mailing Address - Fax:907-260-7400
Practice Address - Street 1:35105 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7621
Practice Address - Country:US
Practice Address - Phone:907-260-7444
Practice Address - Fax:907-260-7400
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2290225100000X
AK2325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist