Provider Demographics
NPI:1326017641
Name:GORMAN, HEATHER (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAWTHORNE ST
Mailing Address - Street 2:MAPLE TREE PLACE
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8212
Mailing Address - Country:US
Mailing Address - Phone:802-876-6000
Mailing Address - Fax:
Practice Address - Street 1:30 HAWTHORNE ST
Practice Address - Street 2:MAPLE TREE PLACE
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8212
Practice Address - Country:US
Practice Address - Phone:802-876-6000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-00034952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT384013OtherMVP
VT58982OtherBC/BS
VT4691002OtherFAHC/VMC PREFERRED APEX
VT1009343Medicaid
VTVN3839Medicare ID - Type Unspecified