Provider Demographics
NPI:1881266740
Name:GORDON, CAROLYN N (PTA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:N
Last Name:GORDON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 VILLA DR APT E
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-3079
Mailing Address - Country:US
Mailing Address - Phone:724-355-8137
Mailing Address - Fax:
Practice Address - Street 1:134 MARWOOD RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-2245
Practice Address - Country:US
Practice Address - Phone:724-352-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI004205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist