Provider Demographics
NPI:1932287398
Name:GORDON, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BODWELL RD
Mailing Address - Street 2:APT 23
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-5814
Mailing Address - Country:US
Mailing Address - Phone:603-315-9552
Mailing Address - Fax:
Practice Address - Street 1:143 RAYMOND RD UNIT 8
Practice Address - Street 2:COPPOLA PHYSICAL THERAPY AND FITNESS GYM
Practice Address - City:CANDIA
Practice Address - State:NH
Practice Address - Zip Code:03034-2133
Practice Address - Country:US
Practice Address - Phone:603-483-3355
Practice Address - Fax:603-483-3357
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0740OtherLICENSE#