MEDICARE: WENDY L MCGUIRE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	9424	AZ

General Provider Information

NPI Number	:	1790060663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY L MCGUIRE PTA

Provider Business Mailing Address
First Line	:	1948 MESQUITE AVE
Second Line	:	SUITE 101
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-0000
Country	:	US
Telephone Number	:	928-854-4776
Fax Number	:	928-854-4857

Provider Business Practice Location Address
First Line	:	1948 MESQUITE AVE
Second Line	:	SUITE 101
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-0000
Country	:	US
Telephone Number	:	928-854-4776
Fax Number	:	928-854-4857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/11/2011

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