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General NPI Number Information
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NPI Number | 1417071028
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Entity Type | Individual
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Provider Name | MARY GORBY L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10201 N 35TH AVE # 101
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City | PHOENIX
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State | AZ
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Zip | 85051-9561
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Country | US
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Telephone | 602-751-7317
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Fax |
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Provider Business Mailing Address
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Address Line | 9061 N 37TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85051-3312
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Country | US
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Telephone | 602-751-7317
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-02816P
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License Number State | AZ
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