Provider Demographics
NPI:1255370763
Name:GORDON, MAUREEN E (MSPT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 S SALISBURY BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5458
Mailing Address - Country:US
Mailing Address - Phone:410-860-5910
Mailing Address - Fax:410-860-5912
Practice Address - Street 1:598 CYNWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3875
Practice Address - Country:US
Practice Address - Phone:410-770-9720
Practice Address - Fax:410-770-9725
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010176L225100000X
MD24560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0209209000OtherKEYSTONE EAST
20033074OtherAMERIHEALTH MERCY
522509OtherPERSONAL CHOICE
PA522509OtherHIGHMARK
PT010176LOtherUS DEPT OF LABOR ACS
PA50026508OtherCAPITAL