Provider Demographics
NPI:1588994396
Name:GONYEA, GORDON (PT)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:GONYEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 ROUTE 70 E
Mailing Address - Street 2:SUITE 412
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2210
Mailing Address - Country:US
Mailing Address - Phone:856-795-0110
Mailing Address - Fax:856-354-2243
Practice Address - Street 1:1415 ROUTE 70 E
Practice Address - Street 2:SUITE 412
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2210
Practice Address - Country:US
Practice Address - Phone:856-795-0110
Practice Address - Fax:856-354-2243
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA009493002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics