Provider Demographics
NPI:1417559204
Name:HINSHILLWOOD, MISTY R (LMT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:R
Last Name:HINSHILLWOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 FERNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1367
Mailing Address - Country:US
Mailing Address - Phone:609-923-3839
Mailing Address - Fax:
Practice Address - Street 1:2337 FERNWOOD AVE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1367
Practice Address - Country:US
Practice Address - Phone:609-923-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01347000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist