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General NPI Number Information
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NPI Number | 1124504352
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Entity Type | Individual
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Provider Name | THOMAS HAROLD MCGOWAN MED, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 13001 N OUTER 40 RD STE 2A
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-5941
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Country | US
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Telephone | 314-324-0367
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Fax |
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Provider Business Mailing Address
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Address Line | 8637 BROOKSHIRE LN APT C
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City | SAINT LOUIS
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State | MO
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Zip | 63132-4711
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Country | US
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Telephone | 314-437-6433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2013003673
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License Number State | MO
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