Healthcare Provider Details

I. General information

NPI: 1255370763
Provider Name (Legal Business Name): MAUREEN E GORDON MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 CYNWOOD DR STE 101
EASTON MD
21601-3875
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

V. Phone/Fax

Practice location:
  • Phone: 410-770-9720
  • Fax: 410-770-9725
Mailing address:
  • Phone: 410-860-5910
  • Fax: 410-860-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010176L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24560
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: