| NPI | 1396049995 |
|---|---|
| Former Name | SHANNON KATHLEEN GORDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OC011420) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2016-12-15 |