Provider Demographics
NPI:1366762171
Name:MCGOWAN, LEEANN
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WINDING BROOK DR
Mailing Address - Street 2:2E
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9201
Mailing Address - Country:US
Mailing Address - Phone:518-424-7436
Mailing Address - Fax:
Practice Address - Street 1:532 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2875
Practice Address - Country:US
Practice Address - Phone:802-447-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist