Provider Demographics
NPI:1851825855
Name:GOWDY, MARIAN (ATC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:GOWDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416
Mailing Address - Country:US
Mailing Address - Phone:540-261-8497
Mailing Address - Fax:540-266-3890
Practice Address - Street 1:1 UNIVERSITY HILL DRIVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416
Practice Address - Country:US
Practice Address - Phone:540-261-8497
Practice Address - Fax:540-266-3890
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260024662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer