Basic Information
| Provider Information | |||||||||
| NPI: | 1528666286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOWDY | ||||||||
| FirstName: | MARYLEE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 PENDER CT | ||||||||
| Address2: | |||||||||
| City: | BERRYVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226111447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403363272 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 W 14TH ST | ||||||||
| Address2: | |||||||||
| City: | FRONT ROYAL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226303607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406363500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2020 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305213890 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.