Individual
AUDREY GORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 RAGIN ST, MYRTLE BEACH, SC 29577-3346
(843) 424-4824
Mailing address
1200 RAGIN ST, MYRTLE BEACH, SC 29577-3346
(843) 424-4824
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3032
SC
Other
Enumeration date
05/10/2017
Last updated
05/10/2017
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