Provider Demographics
NPI:1841526860
Name:GORDON, PATRICIA NOLAN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:NOLAN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:MALONEY
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 BENTON CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3720
Mailing Address - Country:US
Mailing Address - Phone:302-439-3446
Mailing Address - Fax:
Practice Address - Street 1:15 BENTON CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3720
Practice Address - Country:US
Practice Address - Phone:302-439-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist