Individual
COLEEN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10210 PROSPERITY PARK DR, CHARLOTTE, NC 28269-5612
(704) 701-7456
Mailing address
PO BOX 42964, CHARLOTTE, NC 28215-0037
(704) 701-7456
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2660
NC
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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