Provider Demographics
NPI:1043767551
Name:GORDON, ZACHARY (DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:654 BEACON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2099
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:101 UNIVERSITY DR
Practice Address - Street 2:SUITE A-6
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2473
Practice Address - Country:US
Practice Address - Phone:413-336-5703
Practice Address - Fax:413-922-2019
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA22521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist