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General NPI Number Information
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NPI Number | 1699946772
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Entity Type | Individual
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Provider Name | DUSTIN CLYDE TINO ATC, LAT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 5765 TRAILWINDS DR UNIT 126
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City | FORT MYERS
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State | FL
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Zip | 33907-7360
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Country | US
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Telephone | 507-236-6728
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Fax |
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Provider Business Mailing Address
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Address Line | 5765 TRAILWINDS DR UNIT 126
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City | FORT MYERS
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State | FL
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Zip | 33907-7360
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Country | US
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Telephone |
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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 | AL2363
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License Number State | FL
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