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NPI Code Detail

MEDICARE: MS. BONNE ROSE MCGOWAN ATC, LAT

MEDICARE: MS. BONNE ROSE MCGOWAN ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerAT-00975OH

General Provider Information

NPI Number : 1225002728
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BONNE ROSE MCGOWAN ATC, LAT
Provider Business Mailing Address
First Line : 5691 SUNBURY RD
Second Line :
City : GAHANNA
State : OH
Zip : 43230-1147
Country : US
Telephone Number : 614-471-9660
Fax Number :
Provider Business Practice Location Address
First Line : 1550 W 5TH AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43212-2495
Country : US
Telephone Number : 614-488-7929
Fax Number : 614-488-5792
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 07/08/2007

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