Healthcare Provider Details

I. General information

NPI: 1205172459
Provider Name (Legal Business Name): COLIN KENNETH MCGOWAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 TAYLOR STREET BUILDING A
FORT BRAGG NC
28310
US

IV. Provider business mailing address

2817 ROCK MERRITT AVENUE WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-432-3789
  • Fax:
Mailing address:
  • Phone: 910-907-8922
  • Fax: 910-907-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP14048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: