Healthcare Provider Details

I. General information

NPI: 1497911036
Provider Name (Legal Business Name): KEVIN VINCENT HYLAND ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BOSTON AVE
POINT PLEASANT BEACH NJ
08742-2697
US

IV. Provider business mailing address

103 BOSTON AVE
POINT PLEASANT BEACH NJ
08742-2697
US

V. Phone/Fax

Practice location:
  • Phone: 732-892-3857
  • Fax: 738-528-7294
Mailing address:
  • Phone: 732-892-3857
  • Fax: 738-528-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00062600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: