Individual
MRS. KELLY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
151 E REDSTONE AVE, CRESTVIEW, FL 32539-5352
(850) 423-1000
Mailing address
147 STRIKE EAGLE DR, CRESTVIEW, FL 32536-2240
(931) 801-5183
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA25246
FL
Other
Enumeration date
09/20/2025
Last updated
09/20/2025
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