Provider Demographics
NPI:1659512820
Name:GORDON, LEE D (PT)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:D
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 1:620 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8245
Mailing Address - Country:US
Mailing Address - Phone:360-403-8247
Mailing Address - Fax:
Practice Address - Street 1:620 HAZEL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8245
Practice Address - Country:US
Practice Address - Phone:360-403-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00007417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist