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General NPI Number Information
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NPI Number | 1003860602
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Entity Type | Organization
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Legal Business Name | HAYGOOD PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1024 INDEPENDENCE BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5503
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Country | US
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Telephone | 757-460-1809
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 69030
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City | BALTIMORE
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State | MD
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Zip | 21264-9030
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Country | US
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Telephone | 757-460-1809
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PHYSICAL THERAPIST
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Name | MR. DONALD ALAN MILDREW
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Credential | P.T.
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Telephone | 757-460-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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