Provider Demographics
NPI:1407236755
Name:MAGUIRE, STEPHANIE (PT)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 TULANE AVE
Mailing Address - Street 2:APT 282
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6700
Mailing Address - Country:US
Mailing Address - Phone:207-217-8861
Mailing Address - Fax:504-349-6844
Practice Address - Street 1:920 AVENUE B
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3112
Practice Address - Country:US
Practice Address - Phone:504-349-6804
Practice Address - Fax:504-349-6844
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09050R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist