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Individual
LANCE LEE GARDNER
Active
Individual
LANCE LEE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22795
MD
2251X0800X
Orthopedic Physical Therapist
PT015177
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11227669
CAQH
PA
01
—
2129596000
KEYSTONE
PA
01
—
3117934
US HEALTH CARE
PA
01
—
GA1446210
BLUE SHIELD
PA
Enumeration date
09/26/2006
Last updated
03/15/2024
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