Healthcare Provider Details

I. General information

NPI: 1588695720
Provider Name (Legal Business Name): CHARLES STEVEN HAYES P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 N. MAIN ST.
CAMBRIDGE VT
05444
US

IV. Provider business mailing address

PO BOX 152
CAMBRIDGE VT
05444-0152
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-5803
  • Fax:
Mailing address:
  • Phone: 802-644-5803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400003190
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: