Provider Demographics
NPI:1427389345
Name:GORDON, RENE' LASHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:RENE'
Middle Name:LASHELLE
Last Name:GORDON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 VILSONIA WAY
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9818
Mailing Address - Country:US
Mailing Address - Phone:903-293-4057
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7805
Practice Address - Country:US
Practice Address - Phone:501-268-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32022251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics