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General NPI Number Information
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NPI Number | 1306164355
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Entity Type | Individual
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Provider Name | BETH GORMAN M.S.P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 3075 WOLF RD UNIT 29
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City | WESTCHESTER
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State | IL
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Zip | 60154-5622
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Country | US
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Telephone | 708-223-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 3075 WOLF RD UNIT 29
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City | WESTCHESTER
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State | IL
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Zip | 60154-5622
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Country | US
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Telephone | 708-223-8011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.013425
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License Number State | IL
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