Matthew Gordon, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305211209 Issued in VA

Practice address

12731 Marblestone Dr Ste 202
Woodbridge, VA 22192-8334

Phone

(571) 659-2612

NPI assigned

Jul 13, 2017

Last updated

Jul 13, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

George Washington University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fusion Physiotherapy Associates LLCGroup PAC ID 5092093575, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fusion Physiotherapy Associates LLC

  • Physical Therapist
  • Fredericksburg, VA
  • NPI 1730530213

  DC

  Medicare reassignment Care Compare group NPD
• Lake Ridge Physical Therapy, LLC

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1871598417
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499904000000",
    "number": "1275055071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12544 DILLINGHAM SQ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925259",
            "telephone_number": "703-730-6969",
            "fax_number": "703-730-1169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12731 MARBLESTONE DR STE 202",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928334",
            "telephone_number": "571-659-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MATTHEW",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-13",
        "last_updated": "2017-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behnam M Goudarzi, M.D.
• Deepshikha Goyal, M.D.
• Grace Counseling & Mediation Services LLC

• Physical Therapist in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.