Provider Demographics
NPI:1093976722
Name:GORDON, SHEILA C (ATC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:C
Last Name:GORDON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5643 PLATT SPRINGS ROAD
Mailing Address - Street 2:WHITE KNOLL HIGH SCHOOL
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073
Mailing Address - Country:US
Mailing Address - Phone:803-622-7622
Mailing Address - Fax:
Practice Address - Street 1:5643 PLATT SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073
Practice Address - Country:US
Practice Address - Phone:803-622-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer