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General NPI Number Information
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NPI Number | 1043421134
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Entity Type | Individual
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Provider Name | DAVE GARDNER PT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 1781 NORTH COMMONS LOOP
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City | TUSCALOOSA
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State | AL
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Zip | 35406-3577
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Country | US
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Telephone | 205-752-0845
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Fax | 205-752-0866
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Provider Business Mailing Address
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Address Line | 1781 NORTH COMMONS LOOP
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City | TUSCALOOSA
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State | AL
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Zip | 35406-3577
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Country | US
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Telephone | 205-752-0845
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Fax | 205-752-0866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH763
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License Number State | AL
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