Provider Demographics
NPI:1063690402
Name:GORDON, PERRY (DPT)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 SAN FELIPE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1546
Mailing Address - Country:US
Mailing Address - Phone:408-238-1552
Mailing Address - Fax:408-841-7203
Practice Address - Street 1:15100 LOS GATOS BLVD.
Practice Address - Street 2:SUITE #1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:408-358-1459
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist