Provider Demographics
NPI:1700915162
Name:MCGOVERN, BRIDGET M (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:M
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:PT, ATC
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:781-383-6719
Mailing Address - Fax:
Practice Address - Street 1:300 FENWAY
Practice Address - Street 2:SIMMONS COLLEGE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5820
Practice Address - Country:US
Practice Address - Phone:617-521-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6361225100000X
MA5492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer