Provider Demographics
NPI:1376748533
Name:GORSKI, SARAH ELIZABETH (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:GORSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9345 W STATE ROAD 8
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:IN
Mailing Address - Zip Code:46348-9584
Mailing Address - Country:US
Mailing Address - Phone:219-754-1024
Mailing Address - Fax:
Practice Address - Street 1:50 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-8774
Practice Address - Country:US
Practice Address - Phone:219-996-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000961A246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3600961AOtherATHLETIC TRAINER