Provider Demographics
NPI:1477220978
Name:MCGOVERN, HEATHER MAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ED COLES CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9814
Mailing Address - Country:US
Mailing Address - Phone:910-389-4069
Mailing Address - Fax:
Practice Address - Street 1:3000 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4504
Practice Address - Country:US
Practice Address - Phone:919-684-2445
Practice Address - Fax:919-668-6105
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist