Provider Demographics
NPI:1235303397
Name:HAYNES, ELLEN DENISE
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:DENISE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156A SEASHORE PT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8692
Mailing Address - Country:US
Mailing Address - Phone:870-703-8589
Mailing Address - Fax:
Practice Address - Street 1:156A SEASHORE PT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-8692
Practice Address - Country:US
Practice Address - Phone:870-703-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2049225200000X
TX2061257225200000X
ARPTA2049225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant