Provider Demographics
NPI:1306063847
Name:GARDNER, JUDITH LEFFLER (PT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LEFFLER
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-1905
Mailing Address - Country:US
Mailing Address - Phone:770-718-9238
Mailing Address - Fax:
Practice Address - Street 1:295 CAPRI DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-1752
Practice Address - Country:US
Practice Address - Phone:770-536-1633
Practice Address - Fax:770-536-0197
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0082312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1134284276OtherNPI CORPORATION ID NUMBER