Individual
MR. LEO GORNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
613 HAMMONDS LN, BROOKLYN, MD 21225-3351
(410) 636-3400
Mailing address
20 REDMILE CT, REISTERSTOWN, MD 21136-3538
(410) 960-7900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16840
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400654200
—
MD
01
—
54478442
BLUE CROSS BLUE SHIELD
MD
Enumeration date
07/28/2006
Last updated
01/27/2022
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