Healthcare Provider Details

I. General information

NPI: 1063555829
Provider Name (Legal Business Name): DEBORAH RUTH GORDON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FLEET LANDING BLVD
ATLANTIC BEACH FL
32233-4691
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

V. Phone/Fax

Practice location:
  • Phone: 904-708-2323
  • Fax:
Mailing address:
  • Phone: 904-249-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: