Provider Demographics
NPI:1457408940
Name:GARDNER, DANIEL JAMES (MPT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TOLL HOUSE AVE STE H3
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6117
Mailing Address - Country:US
Mailing Address - Phone:240-575-9260
Mailing Address - Fax:240-575-9380
Practice Address - Street 1:801 TOLL HOUSE AVE STE H3
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6117
Practice Address - Country:US
Practice Address - Phone:240-575-9260
Practice Address - Fax:240-575-9380
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ1130001OtherBLUE CHOICE
DE191023OtherCOVENTRY OF DEL
MDKCY2OtherCAREFIRST MD
MDKCY2OtherCAREFIRST MD