Provider Demographics
NPI:1093857831
Name:MCGUIRK, MICHAEL V (PTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:MCGUIRK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 WOODBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2354
Mailing Address - Country:US
Mailing Address - Phone:812-944-1530
Mailing Address - Fax:
Practice Address - Street 1:9407 HIGHWAY 403
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8946
Practice Address - Country:US
Practice Address - Phone:812-256-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002363A225200000X
KYA01462225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant