MEDICARE: GORDON C DENDY P.T., M.P.T.

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	PT6468	TN
2	225100000X	Physical Therapist	PT3860	MS

General Provider Information

NPI Number	:	1528014073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON C DENDY P.T., M.P.T.

Provider Business Mailing Address
First Line	:	421 E COMMERCE ST
Second Line	:
City	:	HERNANDO
State	:	MS
Zip	:	38632-2348
Country	:	US
Telephone Number	:	662-449-2811
Fax Number	:	662-449-2812

Provider Business Practice Location Address
First Line	:	9085 SANDIDGE CENTER CV
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-3575
Country	:	US
Telephone Number	:	662-890-2663
Fax Number	:

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	10/24/2024

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