Individual
KEVIN GREGORY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
4701 KENMORE AVE, SUITE 121, ALEXANDRIA, VA 22304-2230
(703) 861-0890
Mailing address
4701 KENMORE AVE, SUITE 121, ALEXANDRIA, VA 22304-1203
(703) 861-0890
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019012178
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4701
—
VA
Enumeration date
02/28/2020
Last updated
02/28/2020
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