Provider Demographics
NPI:1194223453
Name:MAGUIRE, SUZANNE MICHELLE (MPT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4043
Mailing Address - Country:US
Mailing Address - Phone:408-434-2277
Mailing Address - Fax:408-434-2278
Practice Address - Street 1:480 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4043
Practice Address - Country:US
Practice Address - Phone:408-434-2277
Practice Address - Fax:408-434-2278
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist