Provider Demographics
NPI:1801881727
Name:GORANSON, DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:GORANSON
Suffix:
Gender:M
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:PO BOX 495665
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5665
Mailing Address - Country:US
Mailing Address - Phone:941-575-8228
Mailing Address - Fax:941-575-9743
Practice Address - Street 1:324 CROSS ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4802
Practice Address - Country:US
Practice Address - Phone:941-575-8228
Practice Address - Fax:941-575-9743
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00712311Medicare PIN