MEDICARE: KACEE JOYCE MCGOUGH 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	13570	MN
2	225100000X	Physical Therapist	2701	ND

General Provider Information

NPI Number	:	1578304846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACEE JOYCE MCGOUGH PT

Provider Business Mailing Address
First Line	:	3770 S WASHINGTON ST STE A
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7824
Country	:	US
Telephone Number	:	701-757-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3770 S WASHINGTON ST STE A
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7824
Country	:	US
Telephone Number	:	701-757-2555
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/11/2026

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Directions to “ KACEE JOYCE MCGOUGH PT” Practice Location

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