Provider Demographics
NPI:1144060450
Name:HAYES, JIM JERMAINE (PTA)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:JERMAINE
Last Name:HAYES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1244
Mailing Address - Country:US
Mailing Address - Phone:580-341-0917
Mailing Address - Fax:
Practice Address - Street 1:28650 NEWHALL RANCH RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-6066
Practice Address - Country:US
Practice Address - Phone:661-466-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53204225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant