Provider Demographics
NPI:1447871090
Name:MCDORMAN, JOHN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCDORMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LANMAN RD
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3622
Mailing Address - Country:US
Mailing Address - Phone:850-685-2270
Mailing Address - Fax:
Practice Address - Street 1:249 MACK BAYOU LOOP STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7197
Practice Address - Country:US
Practice Address - Phone:850-622-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist