Healthcare Provider Details

I. General information

NPI: 1174409015
Provider Name (Legal Business Name): GWYNETH E GORLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 PAOLI PIKE STE 1
FLOYDS KNOBS IN
47119-9787
US

IV. Provider business mailing address

3620 PAOLI PIKE STE 1
FLOYDS KNOBS IN
47119-9787
US

V. Phone/Fax

Practice location:
  • Phone: 812-903-0001
  • Fax:
Mailing address:
  • Phone: 812-903-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016115A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: