Provider Demographics
NPI:1932124781
Name:GORDON, ANGELA T (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:T
Last Name:GORDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:T
Other - Last Name:CAPARSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4500 S FOUR MILE RUN DR
Mailing Address - Street 2:223
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 SHAWNEE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2300
Practice Address - Country:US
Practice Address - Phone:703-256-4830
Practice Address - Fax:703-256-4826
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist