Provider Demographics
NPI:1952429078
Name:GORDON, JULIE M (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:GORDON
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1911 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-3804
Mailing Address - Country:US
Mailing Address - Phone:303-267-3282
Mailing Address - Fax:
Practice Address - Street 1:30940 STAGECOACH BLVD STE E270
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7782
Practice Address - Country:US
Practice Address - Phone:303-647-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003338225100000X
IL070.007460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K04257Medicare PIN