MEDICARE: MRS. JENNIFER 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	21047	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487615027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER GORDON PT

Provider Business Mailing Address
First Line	:	7500 HANOVER PKWY STE 103
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-2011
Country	:	US
Telephone Number	:	301-446-1644
Fax Number	:	301-446-1647

Provider Business Practice Location Address
First Line	:	14999 HEALTH CENTER DR STE 201
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1087
Country	:	US
Telephone Number	:	240-245-4245
Fax Number	:	240-245-4916

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	10/01/2013

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