Provider Demographics
NPI:1144383415
Name:GORDON, CARRIE KATZ (DPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:KATZ
Last Name:GORDON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W ILLINOIS ST
Mailing Address - Street 2:UNIT 5F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3658
Mailing Address - Country:US
Mailing Address - Phone:312-929-2520
Mailing Address - Fax:
Practice Address - Street 1:100 E IRVING PARK RD
Practice Address - Street 2:ST 107
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2048
Practice Address - Country:US
Practice Address - Phone:630-439-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176832251X0800X
IL070.0136102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208324001Medicare PIN