MEDICARE: ERICKA GARDNER LMBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	10199	NC

General Provider Information

NPI Number	:	1073953485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA GARDNER LMBT

Provider Business Mailing Address
First Line	:	6532 ROCKWELL BLVD W
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-2053
Country	:	US
Telephone Number	:	917-557-6362
Fax Number	:

Provider Business Practice Location Address
First Line	:	6532 ROCKWELL BLVD W
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-2053
Country	:	US
Telephone Number	:	917-557-6362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2013
Last Update Date	:	06/29/2013

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