Provider Demographics
NPI:1699294470
Name:GARDINIER, RAYMOND (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:GARDINIER
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1179
Mailing Address - Country:US
Mailing Address - Phone:859-916-1334
Mailing Address - Fax:
Practice Address - Street 1:3755 OLD KY 17
Practice Address - Street 2:
Practice Address - City:FORT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-916-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
KY007342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist