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Individual
MICHAEL C GORMLEY
Active
Individual
MICHAEL C GORMLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001405
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010236301
UNIVERA
NY
01
—
000607209001
BLUE CROSS BLUE SHIELD
NY
05
—
00609485
—
NY
01
—
9308303
INDEPENDENT HEALTH
NY
Enumeration date
08/31/2006
Last updated
11/05/2012
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