MEDICARE: SAMI JO MAGOFFIN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		AR

General Provider Information

NPI Number	:	1689669897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMI JO MAGOFFIN PA

Provider Business Mailing Address
First Line	:	140 CORDOBA CENTER DR
Second Line	:
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-4020
Country	:	US
Telephone Number	:	501-922-1686
Fax Number	:	501-922-9735

Provider Business Practice Location Address
First Line	:	140 CORDOBA CENTER DR
Second Line	:
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-4020
Country	:	US
Telephone Number	:	501-922-1686
Fax Number	:	501-922-9735

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SAMI JO MAGOFFIN
Credential	:	PT
Telephone Number	:	501-922-1686

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/21/2022

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