Provider Demographics
NPI:1902894660
Name:HAYNES SPORTS THERAPY AND REHAB, INC.
Entity Type:Organization
Organization Name:HAYNES SPORTS THERAPY AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-777-6798
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-0068
Mailing Address - Country:US
Mailing Address - Phone:870-777-6798
Mailing Address - Fax:870-777-6880
Practice Address - Street 1:206 N HERVEY ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-3613
Practice Address - Country:US
Practice Address - Phone:870-777-6798
Practice Address - Fax:870-777-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B934OtherBC BS PROVIDER CLINIC NUM
AR5B934OtherBC BS PROVIDER CLINIC NUM