Individual
KATHY GORUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1503 W 6TH ST, SILVER CITY, NM 88061-3703
(575) 574-0637
Mailing address
1503 W 6TH ST, SILVER CITY, NM 88061-3703
(575) 574-0637
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5002
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5002
NEW MEXICO MASSAGE THERAPY BOARD
NM
Enumeration date
02/10/2009
Last updated
02/10/2009
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