Healthcare Provider Details

I. General information

NPI: 1548554264
Provider Name (Legal Business Name): ELIZABETH ANN MCGUIRE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 BRENT CIR
OLDSMAR FL
34677-3342
US

IV. Provider business mailing address

143 BRENT CIR
OLDSMAR FL
34677-3342
US

V. Phone/Fax

Practice location:
  • Phone: 813-792-7566
  • Fax:
Mailing address:
  • Phone: 813-792-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 21791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: