Provider Demographics
NPI:1043560469
Name:GORDON, KATHERINE MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 13 AVE SOUTH
Mailing Address - Street 2:SUITE NO. 4
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-217-4251
Mailing Address - Fax:406-315-3035
Practice Address - Street 1:324 13 AVE SOUTH
Practice Address - Street 2:SUITE NO. 4
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-217-4251
Practice Address - Fax:406-315-3035
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1900225700000X
MTNO.1900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist