Provider Demographics
NPI:1295400307
Name:GORDON, HALIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 FALLON RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4276
Mailing Address - Country:US
Mailing Address - Phone:510-498-3900
Mailing Address - Fax:
Practice Address - Street 1:3918 FALLON RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4276
Practice Address - Country:US
Practice Address - Phone:510-498-3900
Practice Address - Fax:925-875-6217
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist