Provider Demographics
NPI:1598218935
Name:MCGOWAN, MATTHEW KYLE (DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KYLE
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9918 GULF COAST MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9023
Mailing Address - Country:US
Mailing Address - Phone:833-493-4325
Mailing Address - Fax:
Practice Address - Street 1:10058 GULF CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8961
Practice Address - Country:US
Practice Address - Phone:833-493-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 45872255A2300X
FLPT42057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL 4587OtherDEPARTMENT OF HEALTH
FLPT42057OtherDEPARTMENT OF HEALTH