Provider Demographics
NPI:1285838532
Name:GORMAN, JOSIE ALBERTO (LICENSED PT)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:ALBERTO
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LICENSED PT
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:ALBERTO
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1878 N MARBLE RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4574
Mailing Address - Country:US
Mailing Address - Phone:520-290-0009
Mailing Address - Fax:520-546-7002
Practice Address - Street 1:1952 FORT UNION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6878
Practice Address - Country:US
Practice Address - Phone:800-574-4792
Practice Address - Fax:801-495-5303
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist