MEDICARE: TODD MCGOWAN PT

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
1	225100000X	Physical Therapist	PT 15974	FL

General Provider Information

NPI Number	:	1447316039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD MCGOWAN PT

Provider Business Mailing Address
First Line	:	2928 NW 41ST AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-1540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 NW 41ST AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-1540
Country	:	US
Telephone Number	:	352-377-1074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	01/20/2010

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