Provider Demographics
NPI:1730263815
Name:MCGOVERN, MARYBETH (MS, PT)
Entity type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:MS, PT
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Mailing Address - Street 1:66 NOOSENECK HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-1523
Mailing Address - Country:US
Mailing Address - Phone:401-397-8399
Mailing Address - Fax:401-397-8398
Practice Address - Street 1:66 NOOSENECK HILL RD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1523
Practice Address - Country:US
Practice Address - Phone:401-397-8399
Practice Address - Fax:401-397-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIRI9432251S0007X
RI943208100000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP08391Medicare UPIN