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General NPI Number Information
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NPI Number | 1932990686
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Entity Type | Individual
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Provider Name | BENJAMIN LAWRENCE GORDON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 33089 GROESBECK HWY
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City | FRASER
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State | MI
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Zip | 48026-1501
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Country | US
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Telephone | 586-296-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 46253 FREMONT LN
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City | CANTON
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State | MI
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Zip | 48187-6733
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501303983
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License Number State | MI
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