MEDICARE: GARDNER KELLY REHABILITATION

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

General Provider Information

NPI Number	:	1942330352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER KELLY REHABILITATION

Provider Business Mailing Address
First Line	:	9350 S 150 E # 460
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2702
Country	:	US
Telephone Number	:	801-255-4999
Fax Number	:	801-748-1865

Provider Business Practice Location Address
First Line	:	9350 S 150 E # 460
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2702
Country	:	US
Telephone Number	:	801-255-4999
Fax Number	:	801-748-1865

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	GREGORY J GARDNER
Credential	:	PHYSICAL THERAPY
Telephone Number	:	801-255-4999

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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