Provider Demographics
NPI:1861470973
Name:MCGOVERN, DANIEL (PT,DPT,SCS,ATC,CSCS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:PT,DPT,SCS,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 STOCKBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1842
Mailing Address - Country:US
Mailing Address - Phone:617-838-2776
Mailing Address - Fax:
Practice Address - Street 1:1004 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-3018
Practice Address - Country:US
Practice Address - Phone:617-838-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6953225100000X
MA5512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer