Provider Demographics
NPI:1215690771
Name:GORDON, CHERYL LYNN (LMBT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 JOYCE ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-8130
Mailing Address - Country:US
Mailing Address - Phone:704-467-2535
Mailing Address - Fax:
Practice Address - Street 1:2504 JOYCE ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-8130
Practice Address - Country:US
Practice Address - Phone:704-467-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist