Provider Demographics
NPI:1639485436
Name:GORDIER, SALLY (LMT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:GORDIER
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 1:5660 GREENWOOD PLAZA BLVD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2416
Mailing Address - Country:US
Mailing Address - Phone:303-886-2964
Mailing Address - Fax:720-488-6701
Practice Address - Street 1:5660 GREENWOOD PLAZA BLVD
Practice Address - Street 2:SUITE 506
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2416
Practice Address - Country:US
Practice Address - Phone:303-886-2964
Practice Address - Fax:720-488-6701
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist