Provider Demographics
NPI:1871066654
Name:HINSHAW, MATTHEW DAVID
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:HINSHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WALNUT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7546
Mailing Address - Country:US
Mailing Address - Phone:517-285-4067
Mailing Address - Fax:
Practice Address - Street 1:122 WALNUT CREEK RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7546
Practice Address - Country:US
Practice Address - Phone:517-285-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist