Provider Demographics
NPI:1558359059
Name:MAGOFFIN, SAMI JO
Entity Type:Individual
Prefix:MS
First Name:SAMI
Middle Name:JO
Last Name:MAGOFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CORDOBA CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-4020
Mailing Address - Country:US
Mailing Address - Phone:501-922-1686
Mailing Address - Fax:501-922-9735
Practice Address - Street 1:140 CORDOBA CENTER DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-4020
Practice Address - Country:US
Practice Address - Phone:501-922-1686
Practice Address - Fax:501-922-9735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U438Medicare ID - Type Unspecified
S84095Medicare UPIN