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General NPI Number Information
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NPI Number | 1437308749
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Entity Type | Individual
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Provider Name | RICHARD KEVIN GARDNER PTA
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Gender | Male
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 44610 MONTEREY AVE
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City | PALM DESERT
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State | CA
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Zip | 92260-3326
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Country | US
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Telephone | 760-776-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 1932 W ACACIA AVE #23
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City | HEMET
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State | CA
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Zip | 92545-3786
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Country | US
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Telephone | 951-760-0504
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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 | AT2236
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License Number State | CA
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