Provider Demographics
NPI:1891276739
Name:MCGOWAN, NANCY CLARKE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CLARKE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:SMITH
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:6800 LUCY CORR BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-706-5648
Mailing Address - Fax:
Practice Address - Street 1:6800 LUCY CORR BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6657
Practice Address - Country:US
Practice Address - Phone:804-706-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist