MEDICARE: FIONA KRISTINA GORNICK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6914	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003169566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIONA KRISTINA GORNICK PT

Provider Business Mailing Address
First Line	:	1825 N WILLIAMS
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227
Country	:	US
Telephone Number	:	503-288-2615
Fax Number	:	503-288-0339

Provider Business Practice Location Address
First Line	:	1825 N WILLIAMS AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1864
Country	:	US
Telephone Number	:	503-288-2615
Fax Number	:	503-288-0339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	10/22/2012

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