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NPI Code Detail

MEDICARE: PAUL P GORMAN A.T.,C. ; P.T.A.

MEDICARE: PAUL P GORMAN A.T.,C. ; P.T.A.
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
12255A2300XAthletic Trainer36000651AIN

General Provider Information

NPI Number : 1083601850
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL P GORMAN A.T.,C. ; P.T.A.
Provider Business Mailing Address
First Line : 9400 SLATE RD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47720-8002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 533 W COLUMBIA ST
Second Line :
City : EVANSVILLE
State : IN
Zip : 47710-1617
Country : US
Telephone Number : 812-759-3001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 07/08/2007

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