Provider Demographics
NPI:1154532562
Name:GORDON, LEIGH ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:LEIGH ANN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEIGH ANN
Other - Middle Name:
Other - Last Name:JAFFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6605 NW 75TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3942
Mailing Address - Country:US
Mailing Address - Phone:954-323-4855
Mailing Address - Fax:954-757-2242
Practice Address - Street 1:5118 KINSWOOD RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1304
Practice Address - Country:US
Practice Address - Phone:954-740-1721
Practice Address - Fax:954-757-2242
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist