Provider Demographics
NPI:1780840678
Name:MACGOWAN, JANINE A (PTA)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:A
Last Name:MACGOWAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:DEERING
Mailing Address - State:NH
Mailing Address - Zip Code:03244-6649
Mailing Address - Country:US
Mailing Address - Phone:603-529-2297
Mailing Address - Fax:
Practice Address - Street 1:8 RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:DEERING
Practice Address - State:NH
Practice Address - Zip Code:03244-6649
Practice Address - Country:US
Practice Address - Phone:603-529-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH375225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant