Individual
STACEY GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17500 W 119TH ST, OLATHE, KS 66061-9524
(913) 599-6100
Mailing address
17500 W 119TH ST, OLATHE, KS 66061-9524
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1102188
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200379870A
—
KS
Enumeration date
08/02/2006
Last updated
11/08/2011
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