Healthcare Provider Details

I. General information

NPI: 1508991209
Provider Name (Legal Business Name): RONALD WAYNE HUTCHINS JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 ACADEMY RD
ALBANY NY
12208-3105
US

IV. Provider business mailing address

536 SIBLEY PL
DELMAR NY
12054-2512
US

V. Phone/Fax

Practice location:
  • Phone: 518-429-2308
  • Fax: 518-429-2320
Mailing address:
  • Phone: 518-429-2308
  • Fax: 518-429-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000256
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: