Provider Demographics
NPI:1609993617
Name:GOWL, KATHRYN WATSON (PT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:WATSON
Last Name:GOWL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 RUTHSBURG RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-1950
Mailing Address - Country:US
Mailing Address - Phone:410-758-0315
Mailing Address - Fax:
Practice Address - Street 1:205 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2125
Practice Address - Country:US
Practice Address - Phone:410-758-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist