Provider Demographics
NPI:1982373882
Name:GORDONAS, ARTEMIO JR (LPTA, AAS, MS, BS)
Entity Type:Individual
Prefix:
First Name:ARTEMIO JR
Middle Name:
Last Name:GORDONAS
Suffix:
Gender:M
Credentials:LPTA, AAS, MS, BS
Other - Prefix:
Other - First Name:ARTEMIO JR
Other - Middle Name:
Other - Last Name:GORDONAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA, AAS, MS, BS
Mailing Address - Street 1:1221 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9127
Mailing Address - Country:US
Mailing Address - Phone:616-843-0030
Mailing Address - Fax:
Practice Address - Street 1:1221 E 16TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-9127
Practice Address - Country:US
Practice Address - Phone:616-843-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014888225200000X
INCV2005155225200000X
MI5502006530225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty