Healthcare Provider Details

I. General information

NPI: 1164433082
Provider Name (Legal Business Name): PATRICK JOHN MCGOWAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE SE SUITE D
ALBUQUERQUE NM
87102-3656
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-2294
  • Fax:
Mailing address:
  • Phone: 630-296-2222
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number756
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: