Provider Demographics
NPI:1184362055
Name:HINTON, JEREMY (LAT/ATC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HINTON
Suffix:
Gender:M
Credentials:LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CRAPE MYRTLE CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9460
Mailing Address - Country:US
Mailing Address - Phone:919-413-4564
Mailing Address - Fax:
Practice Address - Street 1:7 CRAPE MYRTLE CIR
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9460
Practice Address - Country:US
Practice Address - Phone:919-413-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer