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General NPI Number Information
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NPI Number | 1275115214
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Entity Type | Individual
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Provider Name | ARIANA J GARDNER ATC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 1700 JR LYNCH STREET
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City | JACKSON
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State | MS
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Zip | 39217-0001
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Country | US
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Telephone | 601-979-2416
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Fax |
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Provider Business Mailing Address
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Address Line | 6803 CHESWICK CT
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City | PARKER
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State | TX
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Zip | 75002-3027
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Country | US
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Telephone | 662-374-3006
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1350316
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT0925
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License Number State | MS
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