Provider Demographics
NPI:1528014073
Name:DENDY, GORDON C (PT, MPT)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:C
Last Name:DENDY
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2348
Mailing Address - Country:US
Mailing Address - Phone:662-449-2811
Mailing Address - Fax:662-449-2812
Practice Address - Street 1:421 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2348
Practice Address - Country:US
Practice Address - Phone:662-449-2811
Practice Address - Fax:662-449-2812
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3860225100000X
TNPT6468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS256594Medicare Oscar/Certification