Basic Information
| Provider Information | |||||||||
| NPI: | 1750580601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORSKI | ||||||||
| FirstName: | KONRAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 CHANDRA DR | ||||||||
| Address2: | |||||||||
| City: | DUNCANNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170209745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178344111 | ||||||||
| FaxNumber: | 7178346332 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 CHANDRA DR | ||||||||
| Address2: | |||||||||
| City: | DUNCANNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170209745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178344111 | ||||||||
| FaxNumber: | 7178346332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT009812L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.