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Individual

JACQUELINE GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
6400 N SANTA FE AVE STE B, OKLAHOMA CITY, OK 73116-9126
(405) 840-2903
(405) 840-3256
Mailing address
1501 REDMAN DR, NEWCASTLE, OK 73065-5635
(405) 361-9609

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1057
OK

Other

Enumeration date
02/24/2014
Last updated
02/24/2014
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