| Doctor Name: | HEAVENLY GORE |
| NPI Number: | 1063725612 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MASSAGE THERAPIST |
| License Number: | M04333 |
| Business Practice Address: | 5530 Wisconsin Ave Chevy Chase, MD - 208154404 |
| Business Phone Number: | 3015406140 |
| Business Fax Number: | 3015405190 |
| Mailing Address: | 20410 Century Blvd, Nrh Regional Rehab - Suite 215 GERMANTOWN |
| State: | MD |
| Postal Code: | 208741186 |
| Phone Number: | 3015406140 |
| Fax Number: | 3015405190 |
| NPI Enumeration Date: | 07/23/2010 |
| NPI Last Update Date: | 07/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | M04333 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |