Provider Demographics
NPI:1235774928
Name:GORNICK, ALEISHA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEISHA
Middle Name:
Last Name:GORNICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-8941
Mailing Address - Country:US
Mailing Address - Phone:406-546-8438
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2252
Practice Address - Country:US
Practice Address - Phone:406-563-0797
Practice Address - Fax:406-563-0796
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-13025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist