Healthcare Provider Details

I. General information

NPI: 1386574606
Provider Name (Legal Business Name): LIAM HAYLES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N HIGHLAND AVE STE 104&105
AURORA IL
60506-1400
US

IV. Provider business mailing address

2531 DICKENS DR
AURORA IL
60503-5768
US

V. Phone/Fax

Practice location:
  • Phone: 630-907-0263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: