Provider Demographics
NPI:1073992970
Name:GORMAN, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 DODGE ST
Mailing Address - Street 2:FH 024C
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68182-0666
Mailing Address - Country:US
Mailing Address - Phone:402-554-2774
Mailing Address - Fax:402-554-4971
Practice Address - Street 1:6001 DODGE ST
Practice Address - Street 2:FH 024C
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-0666
Practice Address - Country:US
Practice Address - Phone:402-554-2774
Practice Address - Fax:402-554-4971
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer