Provider Demographics
NPI:1659774545
Name:GORMAN, SEAN L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:L
Last Name:GORMAN
Suffix:
Gender:M
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 1:1598 COUNTRY WALK DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8669
Mailing Address - Country:US
Mailing Address - Phone:804-212-7285
Mailing Address - Fax:
Practice Address - Street 1:630 ATLANTIC BLVD STE 11
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-4003
Practice Address - Country:US
Practice Address - Phone:904-249-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38573225100000X
VA2305209063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist