Healthcare Provider Details

I. General information

NPI: 1346765922
Provider Name (Legal Business Name): AISSA MARIA MCGUIRL DPT CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 WEST RD UNIT 2B
ELLINGTON CT
06029-3718
US

IV. Provider business mailing address

21756 STATE ROAD 54 STE 102
LUTZ FL
33549-2905
US

V. Phone/Fax

Practice location:
  • Phone: 860-896-0538
  • Fax:
Mailing address:
  • Phone: 727-475-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number11475
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: