Provider Demographics
NPI:1083776280
Name:MCGOWIAN, THOMAS EDWARD (LMP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:MCGOWIAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18235 73RD AVE NE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2756
Mailing Address - Country:US
Mailing Address - Phone:425-485-4693
Mailing Address - Fax:
Practice Address - Street 1:18235 73RD AVE NE
Practice Address - Street 2:SUITE 11
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2756
Practice Address - Country:US
Practice Address - Phone:425-485-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021479225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist