Individual
GORDON LAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
386 W 7TH ST, BOONEVILLE, AR 72927-3143
(479) 965-6752
Mailing address
PO BOX 871, CHARLESTON, AR 72933-0871
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4077
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214357721
—
AR
Enumeration date
07/19/2016
Last updated
07/19/2016
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