Healthcare Provider Details

I. General information

NPI: 1932287398
Provider Name (Legal Business Name): STEVEN GORDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 RAYMOND RD UNIT 8 COPPOLA PHYSICAL THERAPY AND FITNESS GYM
CANDIA NH
03034-2133
US

IV. Provider business mailing address

1107 BODWELL RD APT 23
MANCHESTER NH
03109-5814
US

V. Phone/Fax

Practice location:
  • Phone: 603-483-3355
  • Fax: 603-483-3357
Mailing address:
  • Phone: 603-315-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3443
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: