Provider Demographics
NPI:1245942051
Name:MCGOWAN, AMY K (PTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3145 HARRIS STREET RD
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-5318
Mailing Address - Country:US
Mailing Address - Phone:360-560-2047
Mailing Address - Fax:
Practice Address - Street 1:917 7TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2601
Practice Address - Country:US
Practice Address - Phone:360-425-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant