Provider Demographics
NPI:1730398777
Name:GORDON, DAVID JAY (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:GORDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:237 WINTHROP ST. RT. 44
Mailing Address - Street 2:PERSONAL BEST PHYSICAL THERAPY
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769
Mailing Address - Country:US
Mailing Address - Phone:774-565-0796
Mailing Address - Fax:774-565-8346
Practice Address - Street 1:237 WINTHROP ST. RT. 44
Practice Address - Street 2:PERSONAL BEST PHYSICAL THERAPY
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769
Practice Address - Country:US
Practice Address - Phone:774-565-0796
Practice Address - Fax:774-565-8346
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17727225100000X
CT007472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11008682AMedicaid