Provider Demographics
NPI:1891755369
Name:MCGOVERN, GINA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 EASTON RD
Mailing Address - Street 2:105 CHATEAU
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2027
Mailing Address - Country:US
Mailing Address - Phone:215-659-7759
Mailing Address - Fax:215-659-6658
Practice Address - Street 1:1003 EASTON RD
Practice Address - Street 2:105 CHATEAU
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2027
Practice Address - Country:US
Practice Address - Phone:215-659-7759
Practice Address - Fax:215-659-6658
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0073061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2281036000OtherBC BS PC KS
PA078953RB2Medicare UPIN