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General NPI Number Information
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NPI Number | 1952760431
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Entity Type | Individual
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Provider Name | KEVIN MACINTYRE ATC
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Gender | Male
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 104 SALUDA POINTE DR
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City | LEXINGTON
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State | SC
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Zip | 29072-7295
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Country | US
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Telephone | 215-805-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 ABBERLY VILLAGE CIR UNIT 113
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-2430
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Country | US
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Telephone | 215-805-6626
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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 | 1965
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License Number State | SC
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