Provider Demographics
NPI:1043623820
Name:GORMAN, RAYMOND
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:GORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E PRATER WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8972
Mailing Address - Country:US
Mailing Address - Phone:775-331-1199
Mailing Address - Fax:775-331-1199
Practice Address - Street 1:1450 E PRATER WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8972
Practice Address - Country:US
Practice Address - Phone:775-331-1199
Practice Address - Fax:775-331-1199
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist