Basic Information
| Provider Information | |||||||||
| NPI: | 1730398777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WINTHROP ST. RT. 44 | ||||||||
| Address2: | PERSONAL BEST PHYSICAL THERAPY | ||||||||
| City: | REHOBOTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7745650796 | ||||||||
| FaxNumber: | 7745658346 | ||||||||
| Practice Location | |||||||||
| Address1: | 237 WINTHROP ST. RT. 44 | ||||||||
| Address2: | PERSONAL BEST PHYSICAL THERAPY | ||||||||
| City: | REHOBOTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7745650796 | ||||||||
| FaxNumber: | 7745658346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 17727 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 007472 | CT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 11008682A | 05 | MA | MEDICAID |