Provider Demographics
NPI:1447358247
Name:GORDON, CHRISTEN LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:LEIGH
Last Name:GORDON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHRISTEN
Other - Middle Name:LEIGH
Other - Last Name:NILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:16 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5104
Mailing Address - Country:US
Mailing Address - Phone:207-266-2446
Mailing Address - Fax:207-947-7279
Practice Address - Street 1:16 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5104
Practice Address - Country:US
Practice Address - Phone:207-266-2446
Practice Address - Fax:208-947-7279
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist