Provider Demographics
NPI:1902047582
Name:HAYNES, NANCY JANE (PTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 EASTLAND ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-8919
Mailing Address - Country:US
Mailing Address - Phone:903-217-7947
Mailing Address - Fax:903-454-7537
Practice Address - Street 1:3500 PARK ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5159
Practice Address - Country:US
Practice Address - Phone:903-455-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2069680225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant