Provider Demographics
NPI:1952297988
Name:GORDON, JOSHUA TREMAINE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TREMAINE
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 1:115 ELWELL ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-5015
Mailing Address - Country:US
Mailing Address - Phone:863-738-0645
Mailing Address - Fax:
Practice Address - Street 1:115 ELWELL ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-5015
Practice Address - Country:US
Practice Address - Phone:863-738-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services