Provider Demographics
NPI:1508620592
Name:MCGOUGH, JOHN CALEB (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CALEB
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:CALEB
Other - Last Name:MCGOUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5480 FM 423 STE 2100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-7914
Mailing Address - Country:US
Mailing Address - Phone:214-494-4643
Mailing Address - Fax:214-494-4654
Practice Address - Street 1:5480 FM 423 STE 2100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-7914
Practice Address - Country:US
Practice Address - Phone:214-494-4643
Practice Address - Fax:214-494-4654
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1388567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist