MEDICARE: DR. MARCY DANIELLE GORDY P.T., 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
1	225100000X	Physical Therapist	05007732A	IN

General Provider Information

NPI Number	:	1689866303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCY DANIELLE GORDY P.T., DPT

Provider Business Mailing Address
First Line	:	1500 N RITTER AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3027
Country	:	US
Telephone Number	:	317-355-3227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1924
Country	:	US
Telephone Number	:	317-355-3227
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/16/2007

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