Active NPI
Leo Gorner, PT
- Physical Therapist
- Brooklyn, MD
National Provider Identifier
1679587083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 16840
- Practice address
- 613 Hammonds LN
Brooklyn, MD 21225-3351 - Phone
- (410) 636-3400
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 16840 | MD | Primary |
Addresses
Primary practice location
613 Hammonds LN
Brooklyn, MD 21225-3351
Mailing address
20 Redmile CT
Reisterstown, MD 21136-3538
Phone (410) 960-7900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 400654200 | Medicaid | MD | |
| 54478442 | Other | MD | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16840 | MD | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maryland Healthcare Clinics | Physical Therapist | Past | Accepting new patients |
| Ravenwood Rehabilitation Center LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Baltimore, MD
- NPI 1710920731
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643241600000",
"number": "1679587083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 REDMILE CT",
"city": "REISTERSTOWN",
"state": "MD",
"postal_code": "211363538",
"telephone_number": "410-960-7900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "613 HAMMONDS LN",
"city": "BROOKLYN",
"state": "MD",
"postal_code": "212253351",
"telephone_number": "410-636-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORNER",
"first_name": "LEO",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2022-01-27",
"certification_date": "2022-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "16840",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "400654200",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "54478442",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.