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NPI Code Detail

MEDICARE: SHARI M GORDON DPT

MEDICARE: SHARI M GORDON DPT
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
1225100000XPhysical TherapistPT27067FL

General Provider Information

NPI Number : 1417220088
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHARI M GORDON DPT
Provider Business Mailing Address
First Line : 15924 SW 92ND AVE
Second Line :
City : PALMETTO BAY
State : FL
Zip : 33157-1842
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15924 SW 92ND AVE
Second Line :
City : PALMETTO BAY
State : FL
Zip : 33157-1842
Country : US
Telephone Number : 305-971-1230
Fax Number : 305-971-3095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2012
Last Update Date : 02/13/2012

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Directions to “ SHARI M GORDON DPT” Practice Location

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