Provider Demographics
NPI:1407970312
Name:GOWAN, JULIE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:GOWAN
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 1:1620 SWALLOW ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2332
Mailing Address - Country:US
Mailing Address - Phone:630-301-2379
Mailing Address - Fax:
Practice Address - Street 1:1620 SWALLOW ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2332
Practice Address - Country:US
Practice Address - Phone:630-301-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist