Provider Demographics
NPI:1821858994
Name:GORDON, GARRETT ISAAC (MD, PT, DPT)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:ISAAC
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD, PT, DPT
Other - Prefix:DR
Other - First Name:GARRETT
Other - Middle Name:ISAAC
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PT, DPT
Mailing Address - Street 1:231 ALBERT SABIN WAY, ML 0531
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3177 BELLEVUE AVE.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-0769
Practice Address - Country:US
Practice Address - Phone:513-558-6356
Practice Address - Fax:513-558-0995
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program