Provider Demographics
NPI:1639309297
Name:KINNEY, PAUL (ATC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KINNEY
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 1:1753 9TH ST
Mailing Address - Street 2:202
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4313
Mailing Address - Country:US
Mailing Address - Phone:516-353-1140
Mailing Address - Fax:310-564-1966
Practice Address - Street 1:1753 9TH ST
Practice Address - Street 2:202
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4313
Practice Address - Country:US
Practice Address - Phone:516-353-1140
Practice Address - Fax:310-564-1966
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
069902535OtherNATIONAL ATHLETIC TRAINERS' ASSOCIATION