Provider Demographics
NPI:1477334647
Name:GORHAM, ANN ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:ELIZABETH
Last Name:GORHAM
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 1:2060 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-6826
Mailing Address - Country:US
Mailing Address - Phone:570-465-2150
Mailing Address - Fax:
Practice Address - Street 1:693 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834
Practice Address - Country:US
Practice Address - Phone:570-465-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT005681225100000X
PAPT002870E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist