Healthcare Provider Details

I. General information

NPI: 1205994803
Provider Name (Legal Business Name): KAREN GAIL GARTNER PT, PCS, ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALBERT CREE DR KIDS ON THE MOVE AT RAVNAH
RUTLAND VT
05701-4601
US

IV. Provider business mailing address

41 N STREET EXT
RUTLAND VT
05701-2536
US

V. Phone/Fax

Practice location:
  • Phone: 802-770-1652
  • Fax: 802-747-0021
Mailing address:
  • Phone: 802-775-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number040-0000895
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: