Provider Demographics
NPI:1194050062
Name:GARDNER, DONNA D'LAINE (RRT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:D'LAINE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:D'LAINE
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRT
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:6249
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-8850
Mailing Address - Fax:210-567-8852
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:6249
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-8850
Practice Address - Fax:210-567-8852
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558542279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care