Provider Demographics
NPI:1184151284
Name:HINTON, KYLE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HINTON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 BOUSH ST UNIT 124
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1360
Mailing Address - Country:US
Mailing Address - Phone:571-480-1989
Mailing Address - Fax:
Practice Address - Street 1:2901 GRANBY ST # 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1549
Practice Address - Country:US
Practice Address - Phone:571-480-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260026462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer