Provider Demographics
NPI:1548668155
Name:MAGUIRE, KRISTIN FUNK (ATC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:FUNK
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 2ND ST
Mailing Address - Street 2:161 NELSON FIELDHOUSE
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1301
Mailing Address - Country:US
Mailing Address - Phone:570-389-4668
Mailing Address - Fax:570-389-5006
Practice Address - Street 1:400 E 2ND ST
Practice Address - Street 2:161 NELSON FIELDHOUSE
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1301
Practice Address - Country:US
Practice Address - Phone:570-389-4668
Practice Address - Fax:570-389-5006
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer