Provider Demographics
NPI:1497790216
Name:HINELY, DANIEL ROY (MED, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ROY
Last Name:HINELY
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 LOWELL BETHESDA RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-3611
Mailing Address - Country:US
Mailing Address - Phone:704-853-9414
Mailing Address - Fax:
Practice Address - Street 1:1692 LOWELL BETHESDA RD
Practice Address - Street 2:APARTMENT K
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-3610
Practice Address - Country:US
Practice Address - Phone:704-853-9414
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255A2300X
GA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer