Healthcare Provider Details

I. General information

NPI: 1598629933
Provider Name (Legal Business Name): GRETCHEN DIJOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 DAVIDSON GATEWAY DR
DAVIDSON NC
28036-7033
US

IV. Provider business mailing address

122 BLUFFTON RD
MOORESVILLE NC
28115-5773
US

V. Phone/Fax

Practice location:
  • Phone: 705-599-9287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20148
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: