Provider Demographics
NPI:1447359187
Name:HOUTHUYSEN, TODD WILLIAM (PA)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:WILLIAM
Last Name:HOUTHUYSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1315
Mailing Address - Country:US
Mailing Address - Phone:973-432-6936
Mailing Address - Fax:
Practice Address - Street 1:1303 38TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1315
Practice Address - Country:US
Practice Address - Phone:843-650-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPA4654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ08209Medicare UPIN