Provider Demographics
NPI:1669681185
Name:GORDON, NIKKI PEPINO (RPT)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:PEPINO
Last Name:GORDON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LONGMEADOW
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6340
Mailing Address - Country:US
Mailing Address - Phone:870-536-0199
Mailing Address - Fax:
Practice Address - Street 1:6400 TRINITY DRIVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6340
Practice Address - Country:US
Practice Address - Phone:870-329-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist