Provider Demographics
NPI:1396073110
Name:GARDNER, CELESTE ANN (PT)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:ANN
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 1:1735 RICHARD DR
Mailing Address - Street 2:RM. 123B
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-4400
Mailing Address - Country:US
Mailing Address - Phone:228-392-0228
Mailing Address - Fax:228-392-0229
Practice Address - Street 1:1735 RICHARD DR
Practice Address - Street 2:RM. 123B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-4400
Practice Address - Country:US
Practice Address - Phone:228-392-0228
Practice Address - Fax:228-392-0229
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0857174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist