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General NPI Number Information
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NPI Number | 1043767551
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Entity Type | Individual
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Provider Name | ZACHARY GORDON DPT
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 101 UNIVERSITY DR SUITE A-6
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City | AMHERST
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State | MA
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Zip | 01002-2473
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Country | US
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Telephone | 413-336-5703
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Fax | 413-922-2019
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Provider Business Mailing Address
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Address Line | 654 BEACON ST STE 2
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City | BOSTON
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State | MA
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Zip | 02215-2099
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Country | US
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Telephone | 630-296-2223
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Fax | 630-759-9510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22521
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License Number State | MA
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