Provider Demographics
NPI:1861511784
Name:GORSKI, ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:GORSKI
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 1:3917 FOX TRL
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2300
Mailing Address - Country:US
Mailing Address - Phone:815-788-1020
Mailing Address - Fax:815-788-1422
Practice Address - Street 1:4701 N OAK ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3309
Practice Address - Country:US
Practice Address - Phone:815-788-1020
Practice Address - Fax:815-788-1422
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0035640653OtherBLUE CROSS BLUE SHIELD