Provider Demographics
NPI:1760496848
Name:MCGUIRE, LAURA ANNE-HALL (PT)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ANNE-HALL
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6105 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2935
Mailing Address - Country:US
Mailing Address - Phone:989-839-9309
Mailing Address - Fax:989-633-9170
Practice Address - Street 1:6105 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2935
Practice Address - Country:US
Practice Address - Phone:989-839-9309
Practice Address - Fax:989-633-9170
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP36760001OtherMEDICARE PTAN