Provider Demographics
NPI:1053380691
Name:MCKOWEN, JOSEPH MARK (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARK
Last Name:MCKOWEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-4735
Mailing Address - Country:US
Mailing Address - Phone:864-487-7874
Mailing Address - Fax:864-487-7659
Practice Address - Street 1:1445 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4735
Practice Address - Country:US
Practice Address - Phone:864-487-7874
Practice Address - Fax:864-487-7659
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0347Medicaid
SC1635OtherPT LICENSE
SC1635OtherPT LICENSE