Provider Demographics
NPI:1093727695
Name:HYDE, GORDON M (MSPT,MA,PT,LAT,ATC)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:M
Last Name:HYDE
Suffix:
Gender:M
Credentials:MSPT,MA,PT,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4851
Mailing Address - Country:US
Mailing Address - Phone:918-252-3302
Mailing Address - Fax:
Practice Address - Street 1:7410 E 87TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4851
Practice Address - Country:US
Practice Address - Phone:918-252-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist