Individual
JEFFREY W GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
4850 E BASELINE RD, SUITE 114, MESA, AZ 85206-4625
(480) 396-2781
(480) 854-3094
Mailing address
4850 E BASELINE RD, SUITE 114, MESA, AZ 85206-4625
(480) 396-2781
(480) 854-3094
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8576
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
465630
—
AZ
Enumeration date
09/15/2009
Last updated
10/28/2009
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