Provider Demographics
NPI:1154993939
Name:MCGUIRE, NICCOLE ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICCOLE
Middle Name:ANN
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S ROOSEVELT ST APT 15
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5208
Mailing Address - Country:US
Mailing Address - Phone:605-430-6417
Mailing Address - Fax:
Practice Address - Street 1:414 S 10TH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-3856
Practice Address - Country:US
Practice Address - Phone:605-430-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2320208100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation