Provider Demographics
NPI:1891162889
Name:THULIN, DEVIN (ATC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:THULIN
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 1:357 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4354
Mailing Address - Country:US
Mailing Address - Phone:316-308-1222
Mailing Address - Fax:
Practice Address - Street 1:220 S JEFFERSON ST PRATHER COLISEUM
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71497-0001
Practice Address - Country:US
Practice Address - Phone:318-357-4276
Practice Address - Fax:318-357-5592
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer