Individual
ABBY ILYCE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T., EMT
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
17180
CT
225100000X
Physical Therapist
10234
CT
225100000X
Physical Therapist
Primary
60495067
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2064003
—
WA
Enumeration date
08/25/2014
Last updated
03/17/2018
Update your record
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