MEDICARE: EVAN MCGUIRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT60754987	WA
2	225100000X	Physical Therapist	PT013002	GA

General Provider Information

NPI Number	:	1912421751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN MCGUIRE

Provider Business Mailing Address
First Line	:	2321 S BOLIVAR RD
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99037-9425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4360 JOHNSON FERRY PL
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2063
Country	:	US
Telephone Number	:	770-971-5870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	08/02/2017

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Directions to “ EVAN MCGUIRE ” Practice Location

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