Active NPI
Misty D Gardner, MS, DPT
- Physical Therapist
- Sheridan, WY
National Provider Identifier
1215942099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT1154
- Practice address
- 1333 W 5TH St
Suite 203
Sheridan, WY 82801-2752 - Phone
- (307) 752-9335
- NPI assigned
- Jul 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | PT1154 | WY | Primary |
Addresses
Primary practice location
1333 W 5TH St
Suite 203
Sheridan, WY 82801-2752
Mailing address
PO Box 306
Big Horn, WY 82833-0306
Phone (307) 752-9335
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123365300 | Medicaid | WY |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1154 | WY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eugene F Herman Scottish Rite Childhood Language Disorders Clinic | Physical Therapist | Past | Accepting new patients |
| Pediatric Therapy Clinic | Physical Therapist | 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.
-
- Speech-Language Pathologist
- Billings, MT
- NPI 1881722361
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323043200000",
"number": "1215942099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 306",
"city": "BIG HORN",
"state": "WY",
"postal_code": "828330306",
"telephone_number": "307-752-9335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 W 5TH ST",
"address_2": "SUITE 203",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828012752",
"telephone_number": "307-752-9335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "MISTY",
"middle_name": "D",
"credential": "MS, DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-30",
"last_updated": "2011-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WY",
"license": "PT1154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "123365300",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.