MEDICARE: DEANNA MARIE GARDNER PTA

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	225200000X	Physical Therapy Assistant	006551-1	NY

General Provider Information

NPI Number	:	1982812707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA MARIE GARDNER PTA

Provider Business Mailing Address
First Line	:	124 GROVE ST
Second Line	:
City	:	JOHNSONBURG
State	:	PA
Zip	:	15845-1427
Country	:	US
Telephone Number	:	814-965-2328
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 GROVE ST
Second Line	:
City	:	JOHNSONBURG
State	:	PA
Zip	:	15845-1427
Country	:	US
Telephone Number	:	814-965-2328
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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