Healthcare Provider Details

I. General information

NPI: 1720754054
Provider Name (Legal Business Name): HAYLEY ARMSTRONG PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W CHERRY LN STE D
MERIDIAN ID
83642-8531
US

IV. Provider business mailing address

15106 PRONGHORN DR
CALDWELL ID
83607-9135
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-8593
  • Fax:
Mailing address:
  • Phone: 951-809-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7477
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: