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NPI Code Detail

MEDICARE: TREVOR WESLEY GORING PT,DPT

MEDICARE: TREVOR WESLEY GORING PT,DPT
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
1225100000XPhysical Therapist2305207835VA

General Provider Information

NPI Number : 1053652578
Entity Type Code : Individual
Provider Name (Legal Business Name) : TREVOR WESLEY GORING PT,DPT
Provider Business Mailing Address
First Line : PO BOX 412307
Second Line :
City : BOSTON
State : MA
Zip : 02241-2307
Country : US
Telephone Number : 914-294-4050
Fax Number :
Provider Business Practice Location Address
First Line : 3509 GRANBY ST STE B
Second Line :
City : NORFOLK
State : VA
Zip : 23504-1312
Country : US
Telephone Number : 757-423-8885
Fax Number : 757-423-8886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2013
Last Update Date : 11/27/2024

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