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General NPI Number Information
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NPI Number | 1679781280
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Entity Type | Individual
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Provider Name | JAMES RICHARD PINYAN JR. ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1255 W INTERNATIONAL SPEEDWAY BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2816
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Country | US
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Telephone | 386-258-4665
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Fax |
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Provider Business Mailing Address
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Address Line | 123 BRANDY HILLS DR
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City | PORT ORANGE
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State | FL
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Zip | 32129-3668
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Country | US
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Telephone | 386-761-9265
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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 | AL 1344
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License Number State | FL
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