Basic Information
| Provider Information | |||||||||
| NPI: | 1255370763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 S SALISBURY BLVD STE 1B | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108605910 | ||||||||
| FaxNumber: | 4108605912 | ||||||||
| Practice Location | |||||||||
| Address1: | 598 CYNWOOD DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216013875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107709720 | ||||||||
| FaxNumber: | 4107709725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 04/01/2015 | ||||||||
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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 | PT010176L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 24560 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0209209000 | 01 | KEYSTONE EAST | OTHER | 20033074 | 01 | AMERIHEALTH MERCY | OTHER | 522509 | 01 | PERSONAL CHOICE | OTHER | 522509 | 01 | PA | HIGHMARK | OTHER | PT010176L | 01 | US DEPT OF LABOR ACS | OTHER | 50026508 | 01 | PA | CAPITAL | OTHER |