Healthcare Provider Details

I. General information

NPI: 1831456649
Provider Name (Legal Business Name): MYISHA L HAYES P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N COCKRELL HILL RD
DALLAS TX
75211-1386
US

IV. Provider business mailing address

1310 N COCKRELL HILL RD
DALLAS TX
75211-1386
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-9820
  • Fax:
Mailing address:
  • Phone: 214-575-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1208445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: