Provider Demographics
NPI:1437534633
Name:HINTON, MARK (ATC, FR, FDM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HINTON
Suffix:
Gender:M
Credentials:ATC, FR, FDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6258 W COPPER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6071
Mailing Address - Country:US
Mailing Address - Phone:473-249-5487
Mailing Address - Fax:
Practice Address - Street 1:131 BARNHILL ARENA OFFICE
Practice Address - Street 2:OFFICE 116A
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-575-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist