Provider Demographics
NPI:1881871085
Name:GARDNER, CANDI L (PT)
Entity type:Individual
Prefix:MRS
First Name:CANDI
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CANDI
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:850 43RD AVE
Practice Address - Street 2:STE 300
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-8401
Practice Address - Country:US
Practice Address - Phone:309-743-0300
Practice Address - Fax:309-743-0318
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016385225100000X
IA004157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-016385OtherILLINOIS PT LICENSE
IA004157OtherIOWA PT LICENSE NO
IL070-016385OtherILLINOIS PT LICENSE
IA004157OtherIOWA PT LICENSE NO