Healthcare Provider Details

I. General information

NPI: 1316355381
Provider Name (Legal Business Name): PHILLIP HUGHES AT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S CLEVELAND AVE
WESTERVILLE OH
43081-1397
US

IV. Provider business mailing address

70 S CLEVELAND AVE
WESTERVILLE OH
43081-1397
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax:
Mailing address:
  • Phone: 614-890-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.004327
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: