Healthcare Provider Details

I. General information

NPI: 1073593893
Provider Name (Legal Business Name): DAVID E HAYNES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NW 7TH ST SUITE 302
OKLAHOMA CITY OK
73102-1212
US

IV. Provider business mailing address

708 24TH AVE NW SUITE 100
NORMAN OK
73069-6232
US

V. Phone/Fax

Practice location:
  • Phone: 405-609-3675
  • Fax: 800-506-3795
Mailing address:
  • Phone: 405-321-5969
  • Fax: 405-321-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2087
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: