Individual
OLIVIA CLAIRE GORHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
4402 WILLIAMS DR STE 115, GEORGETOWN, TX 78628-1388
(512) 256-7627
Mailing address
2012 LANGDALE LN, AUSTIN, TX 78754-5510
(832) 797-2131
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1335632
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1335632
PHYSICAL THERAPY LICENSE NUMBER
TX
Enumeration date
09/07/2020
Last updated
09/07/2020
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