NPIMap

Individual provider Active NPI

Lisa Ann McGowan, PT

  • Physical Therapist
  • Norwich, CT
National Provider Identifier
1912102443
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
005190 Issued in CT
Practice address
150 Otrobando Avenue
Norwich, CT 06360
Phone
(860) 889-1948
NPI assigned
Jun 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 005190 CT Primary

Addresses

Primary practice location

150 Otrobando Avenue
Norwich, CT 06360

Mailing address

150 Otrobando Ave
Norwich, CT 06360-2116
Phone (860) 889-1948

Other practice location 1

11 Freedom Way Unit B2
Niantic, CT 06357-1041
Phone (860) 691-8960

Other identifiers 5

IdentifierTypeStateIssuer
0014101OtherCTORTHONET HEALTHNET
14101OtherCTORTHONET CIGNA
004189024MedicaidCT
A2752221OtherCTOXFORD
061503332005OtherCTTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005190CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Neuropsychological Associates, LLC PastSince Nov 20, 2014 Accepting new patients
Eastern Connecticut Rehabilitation Centers Past Accepting new patients
Eastern Connecticut Rehabili Past Accepting new patients
Eastern Connecticut Rehabilitation Centers Past Accepting new patients
Eastern Connecticut Rehabili Past Accepting new patients
Eastern Connecticut Rehabilitation Centers Physical Therapist Past Accepting new patients
Eastern Connecticut Rehabilitation Centers Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1912102443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 OTROBANDO AVE",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602116",
            "telephone_number": "860-889-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 OTROBANDO AVENUE",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "06360",
            "telephone_number": "860-889-1948"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Freedom Way Unit B2",
            "address_purpose": "LOCATION",
            "city": "Niantic",
            "state": "CT",
            "postal_code": "063571041",
            "country_code": "US",
            "telephone_number": "860-691-8960",
            "fax_number": "860-691-8969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCGOWAN",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-15",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "005190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHONET HEALTHNET",
            "identifier": "0014101",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHONET CIGNA",
            "identifier": "14101",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004189024",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A2752221",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "061503332005",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.