Healthcare Provider Details

I. General information

NPI: 1447886353
Provider Name (Legal Business Name): ROSE MCGUIRE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 22ND AVE S
BROOKINGS SD
57006-0850
US

IV. Provider business mailing address

PO BOX 850
BROOKINGS SD
57006-0850
US

V. Phone/Fax

Practice location:
  • Phone: 605-696-7222
  • Fax: 605-692-6624
Mailing address:
  • Phone: 605-696-7222
  • Fax: 605-692-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT10786
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: