Healthcare Provider Details

I. General information

NPI: 1336181916
Provider Name (Legal Business Name): RON HUTCHINS LATC, CSCS, PES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MIRY BROOK RD
DANBURY CT
06810-7417
US

IV. Provider business mailing address

91 MIRY BROOK RD
DANBURY CT
06810-7417
US

V. Phone/Fax

Practice location:
  • Phone: 203-830-3994
  • Fax: 203-830-3958
Mailing address:
  • Phone: 203-830-3994
  • Fax: 203-830-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000009
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: