Provider Demographics
NPI:1578767158
Name:MCGOWAN, REBECCA E (LMT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:E
Other - Last Name:LAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1830 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-9165
Mailing Address - Country:US
Mailing Address - Phone:931-249-9422
Mailing Address - Fax:
Practice Address - Street 1:291 CLEAR SKY CT
Practice Address - Street 2:C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5653
Practice Address - Country:US
Practice Address - Phone:931-920-4333
Practice Address - Fax:931-920-4346
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist