Healthcare Provider Details

I. General information

NPI: 1760959167
Provider Name (Legal Business Name): HEATHER CHRISTINA GURDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEADOW LKS
EAST WINDSOR NJ
08520-4804
US

IV. Provider business mailing address

9 ROCKY BROOK RD
MILLSTONE TOWNSHIP NJ
08535-1036
US

V. Phone/Fax

Practice location:
  • Phone: 609-426-6819
  • Fax:
Mailing address:
  • Phone: 609-462-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB0354100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: