Healthcare Provider Details

I. General information

NPI: 1386371011
Provider Name (Legal Business Name): NATHAN WILLIAM GAARDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 N WOODBINE RD
SAINT JOSEPH MO
64505-9323
US

IV. Provider business mailing address

206 N BODER ST
TROY KS
66087-4209
US

V. Phone/Fax

Practice location:
  • Phone: 816-281-2346
  • Fax:
Mailing address:
  • Phone: 785-850-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: