Provider Demographics
NPI:1871328724
Name:GOREHAB LLC
Entity type:Organization
Organization Name:GOREHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GORACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT,GCS
Authorized Official - Phone:860-729-1196
Mailing Address - Street 1:304 WEST MAIN ST
Mailing Address - Street 2:SUITE 2 308
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-729-1196
Mailing Address - Fax:
Practice Address - Street 1:304 WEST MAIN ST
Practice Address - Street 2:SUITE 2 308
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-729-1196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy