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General NPI Number Information
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NPI Number | 1184151284
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Entity Type | Individual
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Provider Name | KYLE HINTON LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 2901 GRANBY ST # 200
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City | NORFOLK
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State | VA
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Zip | 23504-1549
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Country | US
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Telephone | 571-480-1989
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Fax |
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Provider Business Mailing Address
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Address Line | 388 BOUSH ST UNIT 124
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City | NORFOLK
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State | VA
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Zip | 23510-1360
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Country | US
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Telephone | 571-480-1989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002646
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License Number State | VA
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