Organization
CREATIVE ORTHOTIC LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK RICHARD GORMAN D.P.M. (C.E.O.)
(623) 934-3213
Entity
Organization
Contact information
Practice address
8608 N 59TH AVE, GLENDALE, AZ 85302-5404
(623) 934-3213
(623) 930-1891
Mailing address
8608 N 59TH AVE, GLENDALE, AZ 85302-5404
(623) 934-3213
(623) 930-1891
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/26/2006
Last updated
08/22/2020
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