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General NPI Number Information
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NPI Number | 1063646735
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Entity Type | Individual
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Provider Name | TAKARA HAYWARD DPT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 10700 CHARTER DR SUITE 100
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City | COLUMBIA
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State | MD
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Zip | 21044-3629
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Country | US
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Telephone | 410-910-2351
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Fax | 410-730-2379
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 150
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City | ANNAPOLIS
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State | MD
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Zip | 21401-8953
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Country | US
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Telephone | 443-481-5618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22410
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License Number State | MD
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