MEDICARE: DONNA MICHELLE GARDNER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	5178	TN
2	225700000X	Massage Therapist	1761	GA

General Provider Information

NPI Number	:	1326262510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MICHELLE GARDNER LMT

Provider Business Mailing Address
First Line	:	PO BOX 121
Second Line	:	CHICKAMAUGA
City	:	CHICKAMAUGA
State	:	GA
Zip	:	30707-0121
Country	:	US
Telephone Number	:	423-400-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 N THORNTON AVE
Second Line	:	DALTON
City	:	DALTON
State	:	GA
Zip	:	30720-8517
Country	:	US
Telephone Number	:	706-275-0543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/06/2007

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