Provider Demographics
NPI:1497911036
Name:HYLAND, KEVIN VINCENT (ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:VINCENT
Last Name:HYLAND
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 1:103 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2697
Mailing Address - Country:US
Mailing Address - Phone:732-892-3857
Mailing Address - Fax:738-528-7294
Practice Address - Street 1:103 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-2697
Practice Address - Country:US
Practice Address - Phone:732-892-3857
Practice Address - Fax:738-528-7294
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000626002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer