Provider Demographics
NPI:1700644218
Name:MCGOWEN, JOSH (LMS)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:MCGOWEN
Suffix:
Gender:M
Credentials:LMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PAGE LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-7056
Mailing Address - Country:US
Mailing Address - Phone:614-218-8327
Mailing Address - Fax:
Practice Address - Street 1:9051 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4606
Practice Address - Country:US
Practice Address - Phone:865-474-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000013693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist