Healthcare Provider Details

I. General information

NPI: 1265395743
Provider Name (Legal Business Name): BETH S GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 JORIE BLVD STE 58
OAK BROOK IL
60523-3878
US

IV. Provider business mailing address

900 JORIE BLVD STE 58
OAK BROOK IL
60523-3878
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-9619
  • Fax: 630-895-4235
Mailing address:
  • Phone: 630-832-9619
  • Fax: 630-895-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.004686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: