Basic Information
| Provider Information | |||||||||
| NPI: | 1225154495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3043 EDMONDS RD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194442029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109417599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 PINE ST | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194013040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102397100 | ||||||||
| FaxNumber: | 6103723248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT001013E | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.