Provider Demographics
NPI:1326153420
Name:HILTON, MICHAEL ALAN (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:HILTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 UELLNER RD E
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:AR
Mailing Address - Zip Code:72847-8591
Mailing Address - Country:US
Mailing Address - Phone:479-293-4248
Mailing Address - Fax:
Practice Address - Street 1:3016 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2453
Practice Address - Country:US
Practice Address - Phone:479-967-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer