Provider Demographics
NPI:1104087832
Name:DENSON, ELIZABETH GORDON (PT ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GORDON
Last Name:DENSON
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LEIGH
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5059 DAWN COURT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 DAIRY LANE
Practice Address - Street 2:WOODMONT CENTER
Practice Address - City:FREDRICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405
Practice Address - Country:US
Practice Address - Phone:540-371-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000267225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant