Provider Demographics
NPI:1578524799
Name:CLINE, ANDREW H (MPH, ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:H
Last Name:CLINE
Suffix:
Gender:M
Credentials:MPH, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SOUTH JACKSON ST
Mailing Address - Street 2:SUITE #C1H17
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-6599
Mailing Address - Fax:502-852-1606
Practice Address - Street 1:530 SOUTH JACKSON ST
Practice Address - Street 2:SUITE #C1H17
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-6599
Practice Address - Fax:502-852-1606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT4072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYAT407OtherATHLETIC TRAINER