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General NPI Number Information
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NPI Number | 1073863569
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Entity Type | Individual
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Provider Name | JENNIFER GARDNER LPTA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 1901 TATE SPRINGS RD SUITE 16
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City | LYNCHBURG
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State | VA
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Zip | 24501
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Country | US
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Telephone | 434-200-5407
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Fax |
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Provider Business Mailing Address
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Address Line | 102 NEW KENT DRIVE
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City | GOODE
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State | VA
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Zip | 24556
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Country | US
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Telephone |
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306601823
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License Number State | VA
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