Healthcare Provider Details

I. General information

NPI: 1811234495
Provider Name (Legal Business Name): DUANE DONALD HINER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 7TH AVE S
ST PETERSBURG FL
33701-4820
US

IV. Provider business mailing address

5521 SHASTA DAISY PLACE
LAND O LAKES FL
34639-6734
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4257
  • Fax:
Mailing address:
  • Phone: 813-994-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA14102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: