Basic Information
| Provider Information | |||||||||
| NPI: | 1902494784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | DEANA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6612 S WARD ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801274855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034092133 | ||||||||
| FaxNumber: | 3034092233 | ||||||||
| Practice Location | |||||||||
| Address1: | 10475 SHERIDAN BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800204135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034092133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2021 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 17443 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PTL0017443 | 01 | CO | PT LICENSE | OTHER |