Provider Demographics
NPI:1154374205
Name:GORMAN, GENA R (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:R
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK DR
Mailing Address - Street 2:STE 255
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:32235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3090
Mailing Address - Fax:205-838-6783
Practice Address - Street 1:720 MONTCLAIR RD
Practice Address - Street 2:STE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1964
Practice Address - Country:US
Practice Address - Phone:205-592-1486
Practice Address - Fax:205-592-1764
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51528772OtherBCBS
AL51528776OtherBCBS
AL51528773OtherBCBS
AL51528774OtherBCBS
AL51527054OtherBCBS
AL51528775OtherBCBS
AL51524254OtherBCBS
AL51528772OtherBCBS
AL51528775OtherBCBS