Basic Information
| Provider Information | |||||||||
| NPI: | 1972533461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARDINER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 EMRICK BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109975756 | ||||||||
| FaxNumber: | 6109975762 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 EMRICK BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109975756 | ||||||||
| FaxNumber: | 6109975762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225500000X | RT000828B | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist |
No ID Information.