Provider Demographics
NPI:1124268537
Name:GARDNER, VERA LYNN (LMT)
Entity type:Individual
Prefix:MRS
First Name:VERA
Middle Name:LYNN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:VERA
Other - Middle Name:LYNN
Other - Last Name:BUSCEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5112 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4213
Mailing Address - Country:US
Mailing Address - Phone:727-848-5006
Mailing Address - Fax:727-848-5006
Practice Address - Street 1:5112 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4213
Practice Address - Country:US
Practice Address - Phone:727-848-5006
Practice Address - Fax:727-848-5006
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31752225700000X, 173C00000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA31752OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH
FL290687-00OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK