Healthcare Provider Details

I. General information

NPI: 1346768736
Provider Name (Legal Business Name): KRISTEN MICHELLE MCGOWN PT, DPT, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MICHELLE O'DONNELL PT, DPT, ATC, LAT

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 GUTHRIE AVE BLDG C
DES MOINES IA
50317-3091
US

IV. Provider business mailing address

2555 GUTHRIE AVE BLDG C
DES MOINES IA
50317-3091
US

V. Phone/Fax

Practice location:
  • Phone: 515-299-1729
  • Fax:
Mailing address:
  • Phone: 515-299-1729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number082568
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001187
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: