Provider Demographics
NPI:1639436942
Name:MCGAUGHY, GAIL L (PT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:MCGAUGHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8508 NW NEWGATE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-3095
Mailing Address - Country:US
Mailing Address - Phone:414-322-0517
Mailing Address - Fax:515-289-9649
Practice Address - Street 1:715 SW ANKENY RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-5999
Practice Address - Country:US
Practice Address - Phone:515-289-9696
Practice Address - Fax:515-289-9649
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0651638Medicaid