MEDICARE: TRENT GARDNER PT

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	PT009749	OH

General Provider Information

NPI Number	:	1881606101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENT GARDNER PT

Provider Business Mailing Address
First Line	:	3425 EXECUTIVE PKWY
Second Line	:	SUITE 128
City	:	TOLEDO
State	:	OH
Zip	:	43606-1326
Country	:	US
Telephone Number	:	419-537-0764
Fax Number	:	419-537-0948

Provider Business Practice Location Address
First Line	:	3900 SUNFOREST CT
Second Line	:	SUITE 135
City	:	TOLEDO
State	:	OH
Zip	:	43623-4475
Country	:	US
Telephone Number	:	419-479-7079
Fax Number	:	419-479-7077

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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Directions to “ TRENT GARDNER PT” Practice Location

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