Healthcare Provider Details

I. General information

NPI: 1225248826
Provider Name (Legal Business Name): KAREN LYNN GORDON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3179 STELLA
PORT O CONNOR TX
77982
US

IV. Provider business mailing address

PO BOX 279
PORT O CONNOR TX
77982-0279
US

V. Phone/Fax

Practice location:
  • Phone: 361-983-2782
  • Fax:
Mailing address:
  • Phone: 361-983-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1018703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: