Provider Demographics
NPI:1992086136
Name:MCGINTY, THERESA LYNN (LMT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:MCGINTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-6610
Mailing Address - Country:US
Mailing Address - Phone:352-486-2003
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN AVE
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-6610
Practice Address - Country:US
Practice Address - Phone:352-486-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0021755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30 0113427OtherEIN