Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT005518L | PA |
NPI | 1093901225 |
---|---|
Provider Name | Susan Leigh Gordon |
First Address | Feasterville Trevose, PA 19053-6026 |
Second Address | Feasterville Trevose, PA 19053-6026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2007 |
Last Update Date | 21/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019326700002 | MA (01) | PA |