Healthcare Provider Details

I. General information

NPI: 1851335384
Provider Name (Legal Business Name): DEBORAH P. GARDINER PT, ATC, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CORNELIA ST SUITE 103
PLATTSBURGH NY
12901-2317
US

IV. Provider business mailing address

PO BOX 2868
PLATTSBURGH NY
12901-0259
US

V. Phone/Fax

Practice location:
  • Phone: 518-314-3371
  • Fax:
Mailing address:
  • Phone: 518-562-4616
  • Fax: 518-562-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003967
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number003967
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010142-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number010142-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002607-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000299
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: