Provider Demographics
NPI:1073193264
Name:HINTON, ETHAN DOUGLAS (PTA)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:DOUGLAS
Last Name:HINTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 KERN WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7804
Mailing Address - Country:US
Mailing Address - Phone:509-895-7449
Mailing Address - Fax:509-895-7452
Practice Address - Street 1:3901 KERN WAY STE 102
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7804
Practice Address - Country:US
Practice Address - Phone:509-985-6583
Practice Address - Fax:509-895-7452
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WA161123003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist