=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548328834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL R GURK MS PT APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 S PALM CANYON DRIVE STE 111
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-327-0500
-----------------------------------------------------
Fax | 760-322-3340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 S PALM CANYON DRIVE STE 111
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-327-0500
-----------------------------------------------------
Fax | 760-322-3340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICAL THERAPIST
-----------------------------------------------------
Name | MICHAEL ROBERT GURK
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 760-327-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT11617
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------