Provider Demographics
NPI:1275899916
Name:MCGUIRE, SHERRY L (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:L
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1800 MONTANA VISTA
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-9363
Mailing Address - Country:US
Mailing Address - Phone:928-855-4664
Mailing Address - Fax:928-453-7607
Practice Address - Street 1:ENGLISH VILLAGE
Practice Address - Street 2:SUITE 315
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0802
Practice Address - Country:US
Practice Address - Phone:928-855-4664
Practice Address - Fax:928-453-7607
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-03867P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-03867POtherLICENSED MASSAGE THERAPIST