Healthcare Provider Details

I. General information

NPI: 1508299470
Provider Name (Legal Business Name): RUDOLPH HINDS JR. CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 TILLMAN ST
MEMPHIS TN
38111-2700
US

IV. Provider business mailing address

2095 WOODEN HEART CT
MEMPHIS TN
38116-8159
US

V. Phone/Fax

Practice location:
  • Phone: 901-254-9939
  • Fax:
Mailing address:
  • Phone: 901-254-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number47543
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: