MEDICARE: GORGET DOUS

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
1	225100000X	Physical Therapist	5501017447	MI

General Provider Information

NPI Number	:	1053785311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORGET DOUS

Provider Business Mailing Address
First Line	:	6634 CHATHAM CIR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4383
Country	:	US
Telephone Number	:	248-892-9228
Fax Number	:

Provider Business Practice Location Address
First Line	:	6634 CHATHAM CIR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4383
Country	:	US
Telephone Number	:	248-892-9228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	11/23/2015

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Directions to “ GORGET DOUS ” Practice Location

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