Provider Demographics
NPI:1285824078
Name:MCGOVERN, ALLISON (PT)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1637
Mailing Address - Country:US
Mailing Address - Phone:856-881-5800
Mailing Address - Fax:856-881-3511
Practice Address - Street 1:601 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1637
Practice Address - Country:US
Practice Address - Phone:856-881-5800
Practice Address - Fax:856-881-3511
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01029100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070380A5LMedicare PIN