MEDICARE: CAROL 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	002520	CT

General Provider Information

NPI Number	:	1366581738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL GORDON PT

Provider Business Mailing Address
First Line	:	1 NORTHWESTERN DR
Second Line	:	SUITE 101
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3400
Country	:	US
Telephone Number	:	860-243-6571
Fax Number	:	860-243-6579

Provider Business Practice Location Address
First Line	:	1 NORTHWESTERN DR
Second Line	:	SUITE101
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3400
Country	:	US
Telephone Number	:	860-243-6571
Fax Number	:	860-243-6579

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/19/2013

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Directions to “ CAROL GORDON PT” Practice Location

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