Provider Demographics
NPI:1700489325
Name:GARDNER, HARLEY MICHELLE
Entity Type:Individual
Prefix:
First Name:HARLEY
Middle Name:MICHELLE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 W VANDERBILT ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3323
Mailing Address - Country:US
Mailing Address - Phone:979-270-2362
Mailing Address - Fax:
Practice Address - Street 1:892 W VANDERBILT ST UNIT C
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3323
Practice Address - Country:US
Practice Address - Phone:979-270-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer