Individual
MR. JEFFREY STEPHEN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1755 WESTWOOD WAY # 7, FAIRBANKS, AK 99709-4064
(907) 479-0623
(888) 761-9303
Mailing address
PO BOX 81062, FAIRBANKS, AK 99708-1062
(907) 479-0623
(888) 761-9303
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
12294
NC
225100000X
Physical Therapist
Primary
1784
AK
225100000X
Physical Therapist
5926
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PT5613
—
AK
Enumeration date
11/10/2006
Last updated
04/13/2011
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