Provider Demographics
NPI:1477860575
Name:MCGOWAN, TRACY (DPT, MTC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36181 E LAKE RD
Mailing Address - Street 2:STE 195
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 EASTLAND BLVD STE 3B
Practice Address - Street 2:NORTHWOOD PLAZA, MEDICAL BLDG. G
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-797-7600
Practice Address - Fax:727-797-7655
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL134872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHP600ZMedicare PIN