MEDICARE: DEBORAH P. GARDINER PT, ATC, CHT

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	225100000X	Physical Therapist	003967	CT
2	2251H1200X	Hand Physical Therapist	003967	CT
3	225100000X	Physical Therapist	010142-1	NY
4	2251H1200X	Hand Physical Therapist	010142-1	NY
5	2255A2300X	Athletic Trainer	002607-1	NY
6	2255A2300X	Athletic Trainer	000299	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851335384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH P. GARDINER PT, ATC, CHT

Provider Business Mailing Address
First Line	:	PO BOX 2868
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-0259
Country	:	US
Telephone Number	:	518-562-4616
Fax Number	:	518-562-7918

Provider Business Practice Location Address
First Line	:	214 CORNELIA ST
Second Line	:	SUITE 103
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2317
Country	:	US
Telephone Number	:	518-314-3371
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	10/04/2016

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Directions to “ DEBORAH P. GARDINER PT, ATC, CHT” Practice Location

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