Provider Demographics
NPI:1619156429
Name:GORE, CAROLINE RICHARDSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:RICHARDSON
Last Name:GORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 ZEIGLERS OUTLET RD
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-1434
Mailing Address - Country:US
Mailing Address - Phone:410-713-0512
Mailing Address - Fax:844-965-9862
Practice Address - Street 1:2375 ZEIGLERS OUTLET RD
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-1434
Practice Address - Country:US
Practice Address - Phone:410-713-0512
Practice Address - Fax:844-965-9862
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16798225100000X
PAPT020938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist