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General NPI Number Information
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NPI Number | 1215008495
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Entity Type | Individual
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Provider Name | JEFFREY STEPHEN GORDON PT
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 1755 WESTWOOD WAY # 7
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City | FAIRBANKS
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State | AK
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Zip | 99709-4064
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Country | US
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Telephone | 907-479-0623
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Fax | 888-761-9303
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Provider Business Mailing Address
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Address Line | PO BOX 81062
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City | FAIRBANKS
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State | AK
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Zip | 99708-1062
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Country | US
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Telephone | 907-479-0623
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Fax | 888-761-9303
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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 | 5926
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1784
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12294
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License Number State | NC
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