Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1164420 | TX |
NPI | 1063779809 |
---|---|
Provider Name | Stephanie R Gordon-Meek |
First Address | Mckinney, TX 75071-7504 |
Second Address | Plano, TX 75075-8844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 18/04/2012 |