Healthcare Provider Details

I. General information

NPI: 1922059450
Provider Name (Legal Business Name): DEBORAH JEANNE MCGUIRE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 N WICKHAM RD
MELBOURNE FL
32940-7304
US

IV. Provider business mailing address

5565 N WICKHAM RD
MELBOURNE FL
32940-7304
US

V. Phone/Fax

Practice location:
  • Phone: 407-573-3352
  • Fax: 407-573-3355
Mailing address:
  • Phone: 407-573-3352
  • Fax: 407-573-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT291674
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8157
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT40841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: