Provider Demographics
NPI:1114410909
Name:MCGOVERN, MARYCLAIRE (DPT)
Entity Type:Individual
Prefix:
First Name:MARYCLAIRE
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MERCHANTS ROW STE 202
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-4488
Mailing Address - Country:US
Mailing Address - Phone:802-857-5407
Mailing Address - Fax:
Practice Address - Street 1:62 MERCHANTS ROW STE 202
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4488
Practice Address - Country:US
Practice Address - Phone:802-857-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0133991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist