Provider Demographics
NPI:1831885730
Name:GORDY, ROBERT LORENZO III
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LORENZO
Last Name:GORDY
Suffix:III
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 1:600 GLEN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5263
Mailing Address - Country:US
Mailing Address - Phone:410-341-9535
Mailing Address - Fax:401-341-9536
Practice Address - Street 1:600 GLEN AVE STE 203
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5263
Practice Address - Country:US
Practice Address - Phone:410-341-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant