Provider Demographics
NPI:1376582973
Name:EILAND, W GORDON (PT SCS ATC)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:GORDON
Last Name:EILAND
Suffix:
Gender:M
Credentials:PT SCS ATC
Other - Prefix:
Other - First Name:GORDON
Other - Middle Name:
Other - Last Name:EILAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5407 NEW COPELAND RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-780-5886
Mailing Address - Fax:903-531-2241
Practice Address - Street 1:5407 NEW COPELAND RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-780-5886
Practice Address - Fax:903-531-2241
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10573882251S0007X
TXAT11932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer