Provider Demographics
NPI:1669900981
Name:GARDNER, BRET (PT, DPT, PN1)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PT, DPT, PN1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 CAPISTRANO TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-4307
Mailing Address - Country:US
Mailing Address - Phone:512-763-0526
Mailing Address - Fax:737-237-0793
Practice Address - Street 1:2329 S 57TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6957
Practice Address - Country:US
Practice Address - Phone:512-763-0526
Practice Address - Fax:737-237-0793
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
TX1293569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist