Clint Lee Anglin, ATC,LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1504 SE 28TH St
Bentonville, AR 72712-3988

Phone

(479) 273-1111

Fax

(479) 273-1255

NPI assigned

Dec 10, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260403200000",
    "number": "1609105253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 SE 28TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123988",
            "telephone_number": "479-273-1111",
            "fax_number": "479-273-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 SE 28TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123988",
            "telephone_number": "479-273-1111",
            "fax_number": "479-273-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANGLIN",
        "first_name": "CLINT",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "ATC,LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-10",
        "last_updated": "2009-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rachel Angulo, MNSC, APRN, CPNP-PC
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• Jillian Antonowicz
• Callie Antuna, OTR
• Aperture Counseling, LLC

• All providers in Bentonville, AR
• Athletic Trainer in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.