Provider Demographics
NPI:1730325465
Name:MCGUIRE, JESSICA (MSPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:NEWSHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:647 SPIRIT AIRPARK WEST DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1032
Mailing Address - Country:US
Mailing Address - Phone:636-223-5700
Mailing Address - Fax:
Practice Address - Street 1:14081 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4513
Practice Address - Country:US
Practice Address - Phone:636-493-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008034219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO150900013Medicare PIN
MO151100013Medicare PIN