Provider Demographics
NPI:1093235616
Name:GORDON PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:GORDON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-315-2500
Mailing Address - Street 1:70 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2427
Mailing Address - Country:US
Mailing Address - Phone:978-315-2500
Mailing Address - Fax:978-315-2501
Practice Address - Street 1:70 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2427
Practice Address - Country:US
Practice Address - Phone:978-315-2500
Practice Address - Fax:978-315-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-24
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty