Healthcare Provider Details

I. General information

NPI: 1295552420
Provider Name (Legal Business Name): MATHEW LAWRENCE GORDON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MANCHESTER SQ STE 170
PORTSMOUTH NH
03801-8089
US

IV. Provider business mailing address

PO BOX 184
YORK ME
03909-0184
US

V. Phone/Fax

Practice location:
  • Phone: 603-988-0953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: