Provider Demographics
NPI:1861969818
Name:HAYWARD, MARK ANTHONY
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:HAYWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1903
Mailing Address - Country:US
Mailing Address - Phone:727-519-8786
Mailing Address - Fax:
Practice Address - Street 1:118 W BAY DR STE 121
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3362
Practice Address - Country:US
Practice Address - Phone:727-459-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59286225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist