Individual
JESSICA MCGUIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60821
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679921
—
OR
01
—
PT60821
LICENSE
OR
Enumeration date
12/17/2012
Last updated
03/24/2015
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