Provider Demographics
NPI:1508065137
Name:GORDON, LUKE S (PT)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:S
Last Name:GORDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N MULLAN RD
Mailing Address - Street 2:#4
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-892-5442
Mailing Address - Fax:509-892-5462
Practice Address - Street 1:626 N MULLAN RD
Practice Address - Street 2:#4
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3861
Practice Address - Country:US
Practice Address - Phone:509-892-5442
Practice Address - Fax:509-892-5462
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPU20001224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist