Individual
MRS. LISA ANN MCGOWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
150 OTROBANDO AVENUE, NORWICH, CT 06360
(860) 889-1948
Mailing address
150 OTROBANDO AVE, NORWICH, CT 06360-2116
(860) 889-1948
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005190
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014101
ORTHONET HEALTHNET
CT
05
—
004189024
—
CT
01
—
061503332005
TRICARE
CT
01
—
14101
ORTHONET CIGNA
CT
01
—
A2752221
OXFORD
CT
Enumeration date
06/15/2007
Last updated
03/17/2018
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