Healthcare Provider Details

I. General information

NPI: 1982373882
Provider Name (Legal Business Name): ARTEMIO JR GORDONAS LPTA, AAS, MS, BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ARTEMIO JR GORDONAS LPTA, AAS, MS, BS

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 E PARIS AVE SE STE 202
GRAND RAPIDS MI
49546-2426
US

IV. Provider business mailing address

2305 E PARIS AVE SE STE 202
GRAND RAPIDS MI
49546-2426
US

V. Phone/Fax

Practice location:
  • Phone: 616-256-0671
  • Fax:
Mailing address:
  • Phone: 616-256-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502006530
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: