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General NPI Number Information
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NPI Number | 1801674361
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Entity Type | Individual
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Provider Name | CHANCE GAUGE RYAN LMBT
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Gender | Male
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 9905 SANDY ROCK PL STE B&D
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City | CHARLOTTE
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State | NC
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Zip | 28277-7734
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Country | US
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Telephone | 704-541-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 5811 MARKET WAY DR APT 3104
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City | CHARLOTTE
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State | NC
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Zip | 28277-4936
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Country | US
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Telephone | 970-734-3094
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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 | 15659
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 135843
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 07961
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License Number State | NC
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