Healthcare Provider Details

I. General information

NPI: 1326731381
Provider Name (Legal Business Name): HALEY WORTHY DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WINDY HILL RD SE
MARIETTA GA
30067-8605
US

IV. Provider business mailing address

2540 WINDY HILL RD SE
MARIETTA GA
30067-8605
US

V. Phone/Fax

Practice location:
  • Phone: 770-644-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016564
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: