Provider Demographics
NPI:1497053870
Name:GORDON, GAIL F (PT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:F
Last Name:GORDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2008
Mailing Address - Country:US
Mailing Address - Phone:510-332-6206
Mailing Address - Fax:
Practice Address - Street 1:2550 9TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2549
Practice Address - Country:US
Practice Address - Phone:510-332-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT117772251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology