Basic Information
| Provider Information | |||||||||
| NPI: | 1730644105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGUFFEY | ||||||||
| FirstName: | GLYNNA | ||||||||
| MiddleName: | TARRANT | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 SHILOH RD STE C120 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757031407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039392800 | ||||||||
| FaxNumber: | 8663864531 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 SHILOH RD STE C120 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757031407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039392800 | ||||||||
| FaxNumber: | 8663864531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2019 | ||||||||
| LastUpdateDate: | 02/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.