Individual
JANELLE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
5955 SHOREVIEW LN N, SUITE 100, KEIZER, OR 97303-3981
(503) 463-4221
(503) 463-4522
Mailing address
11481 SW HALL BLVD, SUITE 201, PORTLAND, OR 97223-8403
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6280
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500630480
—
OR
01
—
P00991058
RR MEDICARE
OR
Enumeration date
09/21/2010
Last updated
02/01/2012
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