Provider Demographics
NPI:1275284622
Name:MAGUIRE, STEPHANIE (CERTIFIED TRAINER)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:CERTIFIED TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 FAIR RD
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-9055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1073 POTTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:SHOEMAKERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19555-1732
Practice Address - Country:US
Practice Address - Phone:717-269-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer