Provider Demographics
NPI:1336388289
Name:MAGUIRE, MICHAEL A (LMP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19542 66TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-3434
Mailing Address - Country:US
Mailing Address - Phone:425-442-0594
Mailing Address - Fax:
Practice Address - Street 1:10125 MAIN PL
Practice Address - Street 2:SUITE A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3457
Practice Address - Country:US
Practice Address - Phone:425-806-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023979225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist