Healthcare Provider Details

I. General information

NPI: 1003860602
Provider Name (Legal Business Name): HAYGOOD PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5503
US

IV. Provider business mailing address

PO BOX 69030
BALTIMORE MD
21264-9030
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-1809
  • Fax:
Mailing address:
  • Phone: 757-460-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD ALAN MILDREW
Title or Position: OWNER/PRESIDENT/PHYSICAL THERAPIST
Credential: P.T.
Phone: 757-460-3363