Provider Demographics
NPI:1720216195
Name:GORMAN, KARIN LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:LYNN
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:LYNN
Other - Last Name:KRIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1238 E CHANDLER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4601
Mailing Address - Country:US
Mailing Address - Phone:480-704-5954
Mailing Address - Fax:480-704-5807
Practice Address - Street 1:1238 E CHANDLER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4601
Practice Address - Country:US
Practice Address - Phone:480-704-5954
Practice Address - Fax:480-704-5807
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8531PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist