Provider Demographics
NPI:1710578349
Name:GORDON, REBECCA MARIE (DPT, CSCS, RYT-200)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:DPT, CSCS, RYT-200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 238TH ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1847
Mailing Address - Country:US
Mailing Address - Phone:917-569-1223
Mailing Address - Fax:
Practice Address - Street 1:7 W 22ND ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5142
Practice Address - Country:US
Practice Address - Phone:212-906-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist