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General NPI Number Information
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NPI Number | 1598218935
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Entity Type | Individual
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Provider Name | MATTHEW KYLE MCGOWAN DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 10058 GULF CENTER DR STE 100
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City | FORT MYERS
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State | FL
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Zip | 33913-8961
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Country | US
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Telephone | 833-493-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 9918 GULF COAST MAIN ST STE 100
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City | FORT MYERS
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State | FL
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Zip | 33913-9023
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Country | US
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Telephone | 833-493-4325
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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 | AL 4587
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT42057
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License Number State | FL
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