Healthcare Provider Details

I. General information

NPI: 1053274100
Provider Name (Legal Business Name): GRACE ERIN MAGUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 COREY ST STE 303
MELROSE MA
02176-4667
US

IV. Provider business mailing address

211 QUISSET LN
WAYNE PA
19087-2184
US

V. Phone/Fax

Practice location:
  • Phone: 617-398-0007
  • Fax:
Mailing address:
  • Phone: 617-398-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL89153
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: