MEDICARE: KAREN LYNN GORDON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1018703	TX

General Provider Information

NPI Number	:	1225248826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNN GORDON PT

Provider Business Mailing Address
First Line	:	PO BOX 279
Second Line	:
City	:	PORT O CONNOR
State	:	TX
Zip	:	77982-0279
Country	:	US
Telephone Number	:	361-983-2782
Fax Number	:

Provider Business Practice Location Address
First Line	:	3179 STELLA
Second Line	:
City	:	PORT O CONNOR
State	:	TX
Zip	:	77982
Country	:	US
Telephone Number	:	361-983-2782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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