Active NPI
Kelly Gordon
- Physical Therapy Assistant
- Crestview, FL
National Provider Identifier
1992677827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA25246
- Practice address
- 151 E Redstone Ave
Crestview, FL 32539-5352 - Phone
- (850) 423-1000
- NPI assigned
- Sep 20, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA25246 | FL | Primary |
Addresses
Primary practice location
151 E Redstone Ave
Crestview, FL 32539-5352
Mailing address
147 Strike Eagle Dr
Crestview, FL 32536-2240
Phone (931) 801-5183
Other practice location 1
1849 E 1st Ave
Crestview, FL 32539-3109
Phone (850) 682-5322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA25246 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758326400000",
"number": "1992677827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 STRIKE EAGLE DR",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325362240",
"telephone_number": "931-801-5183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 E REDSTONE AVE",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325395352",
"telephone_number": "850-423-1000"
}
],
"practiceLocations": [
{
"address_1": "1849 E 1st Ave",
"address_purpose": "LOCATION",
"city": "Crestview",
"state": "FL",
"postal_code": "325393109",
"country_code": "US",
"telephone_number": "850-682-5322",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GORDON",
"first_name": "KELLY",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-20",
"last_updated": "2025-09-20",
"certification_date": "2025-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA25246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.