Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 7654 | MN |
NPI | 1063646511 |
---|---|
Provider Name | Kimberly Gordon |
First Address | Rochester, MN 55903-7197 |
Second Address | Rochester, MN 55901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 21/08/2013 |