Provider Demographics
NPI:1396253324
Name:GARDNER, SARAH REBECCA (AS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:REBECCA
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AS
Mailing Address - Street 1:912 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-5343
Mailing Address - Country:US
Mailing Address - Phone:941-545-2700
Mailing Address - Fax:
Practice Address - Street 1:350 BRADEN AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2001
Practice Address - Country:US
Practice Address - Phone:941-355-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27414225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant