Active NPI
Dave Gardner, PT
- Physical Therapist
- Tuscaloosa, AL
National Provider Identifier
1043421134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTH763
- Practice address
- 1781 North Commons Loop
Tuscaloosa, AL 35406-3577 - Phone
- (205) 752-0845
- Fax
- (205) 752-0866
- NPI assigned
- May 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTH763 | AL | Primary |
Addresses
Primary practice location
1781 North Commons Loop
Tuscaloosa, AL 35406-3577
Mailing address
1781 North Commons Loop
Tuscaloosa, AL 35406-3577
Phone (205) 752-0845
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA763 | Other | AL | ALABAMA PT LICENSE NUMBER |
| 51527979 | Other | AL | BCBS PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTH763 | AL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Alabama Pain Management, LLC | Past | Accepting new patients | |
| Aptor Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Tuscaloosa, AL
- NPI 1134175623
-
- Preferred Provider Organization
- Tuscaloosa, AL
- NPI 1225214018
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357171200000",
"number": "1043421134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1781 NORTH COMMONS LOOP",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354063577",
"telephone_number": "205-752-0845",
"fax_number": "205-752-0866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1781 NORTH COMMONS LOOP",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354063577",
"telephone_number": "205-752-0845",
"fax_number": "205-752-0866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "DAVE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2013-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AL",
"license": "PTH763",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA PT LICENSE NUMBER",
"identifier": "PTA763",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "51527979",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tuscaloosa, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.