Healthcare Provider Details

I. General information

NPI: 1205261716
Provider Name (Legal Business Name): HAYLEY M DAVIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAYLEY SHOEMAKER

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 COPPER AVE NE
ALBUQUERQUE NM
87108-1301
US

IV. Provider business mailing address

317 CORNELL DR SE
ALBUQUERQUE NM
87106-3584
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-7988
  • Fax: 505-268-8021
Mailing address:
  • Phone: 505-301-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4372
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: