Provider Demographics
NPI:1235675794
Name:MCGUFFIN, JONATHAN TAYLOR
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TAYLOR
Last Name:MCGUFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-3712
Mailing Address - Country:US
Mailing Address - Phone:334-445-1380
Mailing Address - Fax:334-445-1489
Practice Address - Street 1:1254 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3712
Practice Address - Country:US
Practice Address - Phone:334-445-1380
Practice Address - Fax:334-445-1489
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH8284OtherPT LICENSE