Provider Demographics
NPI:1346455375
Name:GORMAN, IRA (PT)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:
Last Name:GORMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 MARY BETH RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-4312
Mailing Address - Country:US
Mailing Address - Phone:303-674-3872
Mailing Address - Fax:
Practice Address - Street 1:3333 REGIS BLVD
Practice Address - Street 2:MAIL CODE G-4
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-1154
Practice Address - Country:US
Practice Address - Phone:303-458-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist