Provider Demographics
NPI:1760959167
Name:GURDON, HEATHER CHRISTINA
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CHRISTINA
Last Name:GURDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ROCKY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08535-1036
Mailing Address - Country:US
Mailing Address - Phone:609-462-1271
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOW LKS
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-4804
Practice Address - Country:US
Practice Address - Phone:609-426-6819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB0354100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant