Provider Demographics
NPI:1922063585
Name:MAGUIRE, JILLIAN MARIE (PT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARIE
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:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:910-332-0421
Mailing Address - Fax:
Practice Address - Street 1:29 SHUCKIN ST STE 101
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8725
Practice Address - Country:US
Practice Address - Phone:910-332-0421
Practice Address - Fax:910-251-0421
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922063585Medicaid
2507826Medicare UPIN