Healthcare Provider Details

I. General information

NPI: 1700707643
Provider Name (Legal Business Name): JASON ANDREW HINES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 OAKSIDE ROAD
TOLEDO OH
43615
US

IV. Provider business mailing address

2010 OAKSIDE ROAD
TOLEDO OH
43615
US

V. Phone/Fax

Practice location:
  • Phone: 419-262-2417
  • Fax:
Mailing address:
  • Phone: 419-262-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: