Individual
KRISTOPHER GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 E PORTLAND STREET, PHOENIX, AZ 85004
(602) 320-9109
Mailing address
615 E PORTLAND STREET, UNIT 104, PHOENIX, AZ 85004
(602) 320-9109
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9022A
AZ
Other
Enumeration date
08/12/2013
Last updated
08/12/2013
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