Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT02867 | RI |
N | 2251X0800X | Physical Therapist - Orthopedic | PT02867 | RI |
NPI | 1568836302 |
---|---|
Provider Name | Shannon Marie Gorman |
First Address | Warwick, RI 02886-4394 |
Second Address | Warwick, RI 02886-4394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2015 |
Last Update Date | 17/11/2015 |