Provider Demographics
NPI:1891988366
Name:SHAY, GORDON EMERSON (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:EMERSON
Last Name:SHAY
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 KIRKDALE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3301
Mailing Address - Country:US
Mailing Address - Phone:301-571-5068
Mailing Address - Fax:
Practice Address - Street 1:9131 KIRKDALE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3301
Practice Address - Country:US
Practice Address - Phone:301-571-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist