Healthcare Provider Details

I. General information

NPI: 1770866410
Provider Name (Legal Business Name): LINDSAY BLAIR GORDON D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY BLAIR RICE

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 EAST COLLEGE WAY
MOUNT VERNON WA
98273
US

IV. Provider business mailing address

17782 147TH ST SE
MONROE WA
98272
US

V. Phone/Fax

Practice location:
  • Phone: 360-464-4358
  • Fax: 855-735-8502
Mailing address:
  • Phone: 360-464-4358
  • Fax: 855-735-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1210572
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60913919
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: