Provider Demographics
NPI:1598043879
Name:GORMAN, CHRISTEN KAY (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:KAY
Last Name:GORMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:602-329-8250
Mailing Address - Fax:
Practice Address - Street 1:16611 S 40TH ST STE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0564
Practice Address - Country:US
Practice Address - Phone:480-706-1199
Practice Address - Fax:480-706-3999
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251X0800X
AZ9438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ695387Medicaid