Provider Demographics
NPI:1770800765
Name:GORMAN, JENNIFER L (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ELM ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1967
Mailing Address - Country:US
Mailing Address - Phone:508-799-6538
Mailing Address - Fax:508-799-5535
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1967
Practice Address - Country:US
Practice Address - Phone:508-799-6538
Practice Address - Fax:508-799-5535
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist