Provider Demographics
NPI:1386099364
Name:MAGUIRE, KELLY (MPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
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 1:572 ROUTE 130 STE 4
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2600
Mailing Address - Country:US
Mailing Address - Phone:609-632-2129
Mailing Address - Fax:609-632-2131
Practice Address - Street 1:572 ROUTE 130 STE 4
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2600
Practice Address - Country:US
Practice Address - Phone:609-632-2129
Practice Address - Fax:609-632-2131
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00659600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist