Provider Demographics
NPI:1407236755
Name:MAGUIRE, STEPHANIE (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:MAGUIRE
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 1:31 BANGOR MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3612
Mailing Address - Country:US
Mailing Address - Phone:207-291-5714
Mailing Address - Fax:207-433-1246
Practice Address - Street 1:31 BANGOR MALL BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3612
Practice Address - Country:US
Practice Address - Phone:207-291-5714
Practice Address - Fax:207-433-1246
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist