Provider Demographics
NPI:1104336551
Name:HINES, DAVID (PT/L, DPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:HINES
Suffix:
Gender:M
Credentials:PT/L, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 SUNNYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4467
Mailing Address - Country:US
Mailing Address - Phone:216-280-3691
Mailing Address - Fax:
Practice Address - Street 1:4300 SIDCO DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4537
Practice Address - Country:US
Practice Address - Phone:615-837-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist