Provider Demographics
NPI:1912100439
Name:TRACY INGRAM MCGOWAN
Entity Type:Organization
Organization Name:TRACY INGRAM MCGOWAN
Other - Org Name:THERAPEUTIC CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-6335
Mailing Address - Street 1:1030 BROAD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-7102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 BROAD CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-7102
Practice Address - Country:US
Practice Address - Phone:252-633-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community MobilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2500566AMedicare ID - Type UnspecifiedOCCUPATIONAL THERAPY GROU
NC2510812Medicare UPIN
NC2500566Medicare ID - Type UnspecifiedPHYSICAL THERAPY GROUP