Individual
MARY ELLEN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
514 N BRIGHTLEAF BLVD STE 1202, SMITHFIELD, NC 27577-4486
(919) 934-4997
(919) 934-9280
Mailing address
514 N BRIGHTLEAF BLVD STE 1202, SMITHFIELD, NC 27577-4486
(919) 934-4997
(919) 934-9280
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
—
—
Other
Enumeration date
06/20/2007
Last updated
07/08/2007
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