Individual
HEAVENLY GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
5530 WISCONSIN AVE, CHEVY CHASE, MD 20815-4404
(301) 540-6140
(301) 540-5190
Mailing address
20410 CENTURY BLVD, NRH REGIONAL REHAB - SUITE 215, GERMANTOWN, MD 20874-1186
(301) 540-6140
(301) 540-5190
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M04333
MD
Other
Enumeration date
07/23/2010
Last updated
07/23/2010
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