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Individual

ELIZABETH CLAIRE GANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(704) 355-7760
(704) 355-4231
Mailing address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(704) 355-4231
(704) 355-7760

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12148
NC
225100000X
Physical Therapist
22392
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
093575100
MD
Enumeration date
10/18/2007
Last updated
01/10/2012
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