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General NPI Number Information
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NPI Number | 1922805316
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Entity Type | Individual
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Provider Name | BENJAMIN J GARDNER PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 2875 W 19TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3596
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Country | US
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Telephone | 773-484-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 W 21ST PL APT 1F
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City | CHICAGO
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State | IL
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Zip | 60608-4354
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Country | US
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Telephone | 907-351-7773
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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 | 070.028956
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License Number State | IL
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