Provider Demographics
NPI:1952738064
Name:MCGUIRE, TRAVIS MARY
Entity Type:Individual
Prefix:MS
First Name:TRAVIS
Middle Name:MARY
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 774
Mailing Address - Street 2:
Mailing Address - City:CARNELIAN BAY
Mailing Address - State:CA
Mailing Address - Zip Code:96140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2785 SIERRA VIEW AVE
Practice Address - Street 2:
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-448-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist