Healthcare Provider Details

I. General information

NPI: 1063690402
Provider Name (Legal Business Name): PERRY GORDON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 LOS GATOS BLVD. SUITE #1
LOS GATOS CA
95032
US

IV. Provider business mailing address

4205 SAN FELIPE RD STE 100
SAN JOSE CA
95135-1546
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1460
  • Fax: 408-358-1459
Mailing address:
  • Phone: 408-238-1552
  • Fax: 408-841-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: