MEDICARE: MR. WILLIAM F 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	15496	MA

General Provider Information

NPI Number	:	1326482704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM F GORDON PT

Provider Business Mailing Address
First Line	:	70 MAIN ST STE 201
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-2427
Country	:	US
Telephone Number	:	978-315-2500
Fax Number	:	978-315-2501

Provider Business Practice Location Address
First Line	:	70 MAIN ST STE 201
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-2427
Country	:	US
Telephone Number	:	978-315-2500
Fax Number	:	978-315-2501

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	01/10/2022

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