Provider Demographics
NPI:1386869519
Name:MAGUIRE, LYNN ANNE (PT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANNE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 SOUTH LAKE SHORE DR.
Mailing Address - Street 2:P.O. BOX 676
Mailing Address - City:PANGUITCH LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84759
Mailing Address - Country:US
Mailing Address - Phone:702-378-5338
Mailing Address - Fax:435-676-2000
Practice Address - Street 1:791 SOUTH LAKE SHORE DR.
Practice Address - Street 2:
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759
Practice Address - Country:US
Practice Address - Phone:702-378-5338
Practice Address - Fax:435-676-2000
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261225100000X
UT7072258-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist