Individual
AMANDA ELISE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-3280
Mailing address
630 WEST 168TH STREET, NEW YORK, NY 10032
(212) 305-5847
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
031680
NY
Other
Enumeration date
11/06/2009
Last updated
11/18/2011
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