Healthcare Provider Details

I. General information

NPI: 1619812740
Provider Name (Legal Business Name): HALEY REYNEBEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ROUTE 134 STE 5AND6
SOUTH DENNIS MA
02660-2577
US

IV. Provider business mailing address

9898 FAIR LN
SPRINGDALE AR
72762-8006
US

V. Phone/Fax

Practice location:
  • Phone: 508-385-4212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: