Provider Demographics
NPI:1205933454
Name:GARDIN, FREDRICK ANTHONY (ATC, CSCS, USAW)
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:ANTHONY
Last Name:GARDIN
Suffix:
Gender:M
Credentials:ATC, CSCS, USAW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HARBISON BLVD
Mailing Address - Street 2:APT 2310
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1735
Mailing Address - Country:US
Mailing Address - Phone:803-673-6155
Mailing Address - Fax:
Practice Address - Street 1:500 HARBISON BLVD
Practice Address - Street 2:APT 2310
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1735
Practice Address - Country:US
Practice Address - Phone:803-673-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer