Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | PT11777 | CA |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT11777 | CA |
NPI | 1497053870 |
---|---|
Provider Name | Gail F Gordon |
First Address | Oakland, CA 94611-2008 |
Second Address | Berkeley, CA 94710-2549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2011 |
Last Update Date | 08/03/2011 |