Healthcare Provider Details

I. General information

NPI: 1023657541
Provider Name (Legal Business Name): RICHARD GARDINER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2020
Last Update Date: 01/01/2020
Certification Date: 01/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 S ORLEANS RD
BREWSTER MA
02631-2870
US

IV. Provider business mailing address

383 S ORLEANS RD
BREWSTER MA
02631-2870
US

V. Phone/Fax

Practice location:
  • Phone: 508-240-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9766
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: