Healthcare Provider Details

I. General information

NPI: 1093857831
Provider Name (Legal Business Name): MICHAEL V. MCGUIRK PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 HIGHWAY 403
CHARLESTOWN IN
47111-8946
US

IV. Provider business mailing address

1011 WOODBOURNE DR
NEW ALBANY IN
47150-2354
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-0528
  • Fax:
Mailing address:
  • Phone: 812-944-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002363A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA01462
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: