Individual
LAURA GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6651 MAJESTIC WAY, CARPENTERSVILLE, IL 60110-3438
(224) 357-8398
Mailing address
6651 MAJESTIC WAY, CARPENTERSVILLE, IL 60110-3438
(224) 357-8398
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.00050
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160.000505
PTA LICENSE
IL
Enumeration date
10/14/2015
Last updated
10/14/2015
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