MEDICARE: GAIL 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	2251N0400X	Neurology Physical Therapist	PT11777	CA
2	2251P0200X	Pediatric Physical Therapist	PT11777	CA

General Provider Information

NPI Number	:	1497053870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL F GORDON PT

Provider Business Mailing Address
First Line	:	1318 MOUNTAIN BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2008
Country	:	US
Telephone Number	:	510-332-6206
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 9TH ST
Second Line	:	SUITE 115
City	:	BERKELEY
State	:	CA
Zip	:	94710-2549
Country	:	US
Telephone Number	:	510-332-6206
Fax Number	:

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

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	03/08/2011

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Directions to “ GAIL F GORDON PT” Practice Location

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