Provider Demographics
NPI:1043545643
Name:WORMAN, BEVERLY RUTH
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:RUTH
Last Name:WORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:RUTH
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11436 ASH GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3776
Mailing Address - Country:US
Mailing Address - Phone:586-823-9030
Mailing Address - Fax:
Practice Address - Street 1:19701 VERNIER RD
Practice Address - Street 2:SUITE 280
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1467
Practice Address - Country:US
Practice Address - Phone:313-884-8920
Practice Address - Fax:313-884-8510
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist