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General NPI Number Information
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NPI Number | 1902545858
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Entity Type | Individual
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Provider Name | GREGORY BARDLEY CERTIFIED PEDORTHIST
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Gender | Male
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 1405 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-7377
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Country | US
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Telephone | 636-485-2992
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-7377
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Country | US
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Telephone | 636-485-2992
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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 | 224L00000X
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Taxonomy Name | Pedorthist
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License Number |
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License Number State |
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