Provider Demographics
NPI:1124427398
Name:GORMAN, EMMA (ATC, LAT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E TRINITY MILLS RD
Mailing Address - Street 2:APT 1413
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-7865
Mailing Address - Country:US
Mailing Address - Phone:214-924-3134
Mailing Address - Fax:
Practice Address - Street 1:4100 MERRELL RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-6217
Practice Address - Country:US
Practice Address - Phone:214-358-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT58012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer