Provider Demographics
NPI:1225002728
Name:MCGOWAN, BONNE ROSE (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:BONNE
Middle Name:ROSE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5691 SUNBURY RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1147
Mailing Address - Country:US
Mailing Address - Phone:614-471-9660
Mailing Address - Fax:
Practice Address - Street 1:1550 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2495
Practice Address - Country:US
Practice Address - Phone:614-488-7929
Practice Address - Fax:614-488-5792
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-009752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer