Healthcare Provider Details

I. General information

NPI: 1811238470
Provider Name (Legal Business Name): DUSTIN MATTHEW GARTNER DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 PRESTON RD STE 2074
PLANO TX
75093-5124
US

IV. Provider business mailing address

PO BOX 306393
NASHVILLE TN
37230-6393
US

V. Phone/Fax

Practice location:
  • Phone: 972-905-6622
  • Fax:
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-373-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009666
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1327028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: