Provider Demographics
NPI:1124048947
Name:MAGUIRE, GARY JAMES (MSPT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:JAMES
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4220 132ND ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-8999
Practice Address - Country:US
Practice Address - Phone:425-357-9380
Practice Address - Fax:425-357-9382
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0305497OtherL & I
WA0052459OtherL & I
WA0305498OtherL & I
WA0305474OtherL & I
WA0305483OtherL & I
WA8339913Medicaid
WAG8915720Medicare PIN
AB38124Medicare ID - Type Unspecified
WA0305483OtherL & I
WAG8916917Medicare PIN