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General NPI Number Information
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NPI Number | 1427389345
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Entity Type | Individual
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Provider Name | RENE' LASHELLE GORDON DPT
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Gender | Female
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 400 S MAIN ST STE 500
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City | SEARCY
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State | AR
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Zip | 72143-7805
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Country | US
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Telephone | 501-268-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 63 VILSONIA WAY
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City | VILONIA
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State | AR
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Zip | 72173-9818
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Country | US
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Telephone | 903-293-4057
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Fax |
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 3202
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License Number State | AR
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