Provider Demographics
NPI:1770011249
Name:MCGOWN, JESSIE L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:MCGOWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:888-777-9170
Mailing Address - Fax:
Practice Address - Street 1:11155 TUCKER RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:KS
Practice Address - Zip Code:66075-8401
Practice Address - Country:US
Practice Address - Phone:888-777-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist