Provider Demographics
NPI:1447690201
Name:GARDNER, RICHARD LOUIS (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LOUIS
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 W PAULINE WHITAKER PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7341
Mailing Address - Country:US
Mailing Address - Phone:479-202-0337
Mailing Address - Fax:479-202-0338
Practice Address - Street 1:5001 W PAULINE WHITAKER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7341
Practice Address - Country:US
Practice Address - Phone:479-202-0337
Practice Address - Fax:479-202-0338
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT35812251X0800X, 2251S0007X
ARPT 3581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEPENDINGMedicaid