MEDICARE: DR. KEVIN E GARD DPT, OCS

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	225100000X	Physical Therapist	PT007722L	PA
2	2251X0800X	Orthopedic Physical Therapist	PT007722L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00184928904	OTHER	PA	AMERICHOICE
2	231352630	OTHER	NJ	HORIZON BC/BS
3	815693	OTHER	PA	BC/BS
4	20035880	OTHER	PA	AMERIHEALTH MERCY
5	P2979020	OTHER	PA	OXFORD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	231352630	OTHER	PA	TRICARE
8	3054832	OTHER	PA	AETNA
9	1140267	OTHER	PA	FIRST HEALTH
10	231352630	OTHER	PA	MULTIPLAN
11	231352630	OTHER	PA	UNITED HEALTHCARE
12	XY4653	OTHER	PA	HEALTH NET

General Provider Information

NPI Number	:	1477527141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN E GARD DPT, OCS

Provider Business Mailing Address
First Line	:	1601 CHERRY ST
Second Line	:	MS 21041
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-553-7012
Fax Number	:	215-553-7019

Provider Business Practice Location Address
First Line	:	1601 CHERRY ST
Second Line	:	MS 21041
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-553-7012
Fax Number	:	215-553-7019

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	01/13/2017

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