MEDICARE: MRS. HEATHER GORMAN PT, ATC

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	2251X0800X	Orthopedic Physical Therapist	040-0003495	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	384013	OTHER	VT	MVP
2	58982	OTHER	VT	BC/BS
3	4691002	OTHER	VT	FAHC/VMC PREFERRED APEX
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326017641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER GORMAN PT, ATC

Provider Business Mailing Address
First Line	:	30 HAWTHORNE ST
Second Line	:	MAPLE TREE PLACE
City	:	WILLISTON
State	:	VT
Zip	:	05495-8212
Country	:	US
Telephone Number	:	802-876-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 HAWTHORNE ST
Second Line	:	MAPLE TREE PLACE
City	:	WILLISTON
State	:	VT
Zip	:	05495-8212
Country	:	US
Telephone Number	:	802-876-6000
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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