Provider Demographics
NPI:1205956109
Name:GORDON, PETER (PT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LATTIMORE RD
Mailing Address - Street 2:STE 178
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4159
Mailing Address - Country:US
Mailing Address - Phone:585-442-9110
Mailing Address - Fax:585-442-9049
Practice Address - Street 1:349 W COMMERCIAL ST
Practice Address - Street 2:STE 1275
Practice Address - City:E ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2407
Practice Address - Country:US
Practice Address - Phone:585-264-0370
Practice Address - Fax:585-264-0432
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist