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General NPI Number Information
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NPI Number | 1750157103
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Entity Type | Individual
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Provider Name | JOSHUA GARDINER BS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 2200 BONFORTE BLVD
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City | PUEBLO
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State | CO
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Zip | 81001-4901
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Country | US
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Telephone | 720-737-4856
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Fax |
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Provider Business Mailing Address
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Address Line | 2824 AIRPORT RD APT 119
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3007
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Country | US
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Telephone | 518-256-5507
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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 | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | AT.0002391
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License Number State | CO
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