Provider Demographics
NPI:1407104839
Name:MCGUIRE, TODD ANTWANN
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ANTWANN
Last Name:MCGUIRE
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:PO BOX 270920
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89127-4920
Mailing Address - Country:US
Mailing Address - Phone:910-476-2233
Mailing Address - Fax:
Practice Address - Street 1:6645 WOODMAN AVE
Practice Address - Street 2:APT # 106
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1050
Practice Address - Country:US
Practice Address - Phone:910-476-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner