Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1210343 | TX |
NPI | 1003252024 |
---|---|
Provider Name | Marc Gardner |
First Address | Houston, TX 77057-7036 |
Second Address | Houston, TX 77057-7036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 16/05/2013 |