Individual
MERIDITH TILLEY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
300 E DAVIS ST, MESQUITE, TX 75149-4610
(972) 882-7834
Mailing address
119 RANDY RD, WAXAHACHIE, TX 75165-6406
(972) 824-7714
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5286
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT5286
TEXAS AT LICENSE
TX
Enumeration date
10/24/2017
Last updated
06/16/2018
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