Provider Demographics
NPI:1932244258
Name:MCGUFFIN, MARTHA HANNAH (PTA)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:HANNAH
Last Name:MCGUFFIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:HANNAH
Other - Last Name:BAGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:215 MOUNTAIN VIEW STREET
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693
Mailing Address - Country:US
Mailing Address - Phone:864-710-7309
Mailing Address - Fax:
Practice Address - Street 1:475 ROCHESTER HWY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-2475
Practice Address - Country:US
Practice Address - Phone:610-991-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
SC1048225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC426614Medicare Oscar/Certification