1639309297 NPI number — PAUL KINNEY ATC

Table of content: PAUL KINNEY ATC (NPI 1639309297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639309297 NPI number — PAUL KINNEY ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINNEY
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639309297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1753 9TH ST
Provider Second Line Business Mailing Address:
202
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90404-4313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-353-1140
Provider Business Mailing Address Fax Number:
310-564-1966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1753 9TH ST
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-353-1140
Provider Business Practice Location Address Fax Number:
310-564-1966
Provider Enumeration Date:
07/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 069902535 . This is a "NATIONAL ATHLETIC TRAINERS' ASSOCIATION" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com