Provider Demographics
NPI:1265134910
Name:GORDON, ERIC ANTHONY
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ANTHONY
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 1:18 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1325
Mailing Address - Country:US
Mailing Address - Phone:636-577-1047
Mailing Address - Fax:
Practice Address - Street 1:7068 S OUTER 364
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7757
Practice Address - Country:US
Practice Address - Phone:636-240-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant