Provider Demographics
NPI:1750508016
Name:MCGOVERN, KEVIN J (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 BROADWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3033
Mailing Address - Country:US
Mailing Address - Phone:781-485-1001
Mailing Address - Fax:
Practice Address - Street 1:PERFECT MOTION SPORTS THERAPY
Practice Address - Street 2:485 GREAT ROAD
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-651-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0327328Medicaid
MA0327328Medicaid