Provider Demographics
NPI:1134711054
Name:HAYMOND, IAN CLARK (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:CLARK
Last Name:HAYMOND
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45814 AMBARA CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3425
Mailing Address - Country:US
Mailing Address - Phone:951-375-9223
Mailing Address - Fax:
Practice Address - Street 1:38860 SKY CANYON DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2518
Practice Address - Country:US
Practice Address - Phone:951-304-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2998372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty