Provider Demographics
NPI:1114459104
Name:GOVERN, KAREN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:GOVERN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HUNT PL
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2914
Mailing Address - Country:US
Mailing Address - Phone:410-259-0824
Mailing Address - Fax:
Practice Address - Street 1:1100 GRANDON WAY
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9191
Practice Address - Country:US
Practice Address - Phone:717-761-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant