Provider Demographics
NPI:1316177926
Name:PREVENT INC.
Entity Type:Organization
Organization Name:PREVENT INC.
Other - Org Name:LYNN A. MAGUIRE P.T.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:702-378-5338
Mailing Address - Street 1:791 SOUTH LAKE SHORE DR.
Mailing Address - Street 2:PO BOX 676
Mailing Address - City:PANGUITCH
Mailing Address - State:UT
Mailing Address - Zip Code:84759-0676
Mailing Address - Country:US
Mailing Address - Phone:702-378-5338
Mailing Address - Fax:
Practice Address - Street 1:791 SOUTH LAKE SHORE DR.
Practice Address - Street 2:SUITE 676
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759-0676
Practice Address - Country:US
Practice Address - Phone:702-378-5338
Practice Address - Fax:435-676-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70722582401251E00000X
UT7072258-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7072258-2401OtherPHYSICAL THERAPY LICENSE #