Individual
LANCE LEE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
52 RISING SUN TOWN CTR, RISING SUN, MD 21911-1902
(410) 658-0100
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
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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