Healthcare Provider Details

I. General information

NPI: 1497790216
Provider Name (Legal Business Name): DANIEL ROY HINELY M.ED., L.A.T., A.T.C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 LOWELL BETHESDA RD APARTMENT K
GASTONIA NC
28056-3610
US

IV. Provider business mailing address

1692 LOWELL BETHESDA RD
GASTONIA NC
28056-3611
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-9414
  • Fax:
Mailing address:
  • Phone: 704-853-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: