Alex Gordon, PT, DPT

Individual provider Active NPI Physical Therapist · Machias, NY

NPI 1124632450 · NPPES record last updated Sep 3, 2020

Key facts

NPI
1124632450
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
045977 (NY)
Practice address
The Pines 9822 Ny-16
Machias, NY 14101
Phone
(716) 353-8516
NPI assigned
Sep 3, 2020
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
045977NYMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 045977 NY Yes

Addresses

Primary practice location

The Pines 9822 Ny-16
Machias, NY 14101

Mailing address

79 Kenview Ave
Tonawanda, NY 14217-1417
Phone (716) 698-7152

Other providers in Machias, NY

All providers in Machias, NY · Physical Therapist in New York

Sources for this page

Verify at the official NPI Registry.