Provider Demographics
NPI:1891847802
Name:MOWERY, GAY LYNNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:GAY
Middle Name:LYNNE
Last Name:MOWERY
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 1:5500 MARKET ST
Mailing Address - Street 2:SUITE 127
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2601
Mailing Address - Country:US
Mailing Address - Phone:330-783-2256
Mailing Address - Fax:330-783-5068
Practice Address - Street 1:5500 MARKET ST
Practice Address - Street 2:SUITE 127
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2601
Practice Address - Country:US
Practice Address - Phone:330-783-2256
Practice Address - Fax:330-783-5068
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMO0869651Medicare ID - Type Unspecified