Provider Demographics
NPI:1174894059
Name:MCGONAGLE, ELIZABETH ANN (DPT, ATC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:MCGONAGLE
Suffix:
Gender:F
Credentials:DPT, ATC
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Other - First Name:
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Mailing Address - Street 1:433 SOSCOL AVENUE
Mailing Address - Street 2:SUITE B 191
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-4040
Mailing Address - Country:US
Mailing Address - Phone:707-224-3131
Mailing Address - Fax:707-224-2356
Practice Address - Street 1:433 SOSCOL AVENUE
Practice Address - Street 2:SUITE B 191
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4040
Practice Address - Country:US
Practice Address - Phone:707-224-3131
Practice Address - Fax:707-224-2356
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT38022261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy