Provider Demographics
NPI:1215738125
Name:GORDON, KATLYN (PT)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:GORDON
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10267
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0003
Mailing Address - Country:US
Mailing Address - Phone:501-358-3565
Mailing Address - Fax:
Practice Address - Street 1:2017 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4725
Practice Address - Country:US
Practice Address - Phone:501-358-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist