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General NPI Number Information
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NPI Number | 1144060450
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Entity Type | Individual
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Provider Name | JIM JERMAINE HAYES PTA
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Gender | Male
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 28650 NEWHALL RANCH RD
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City | SANTA CLARITA
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State | CA
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Zip | 91355-6066
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Country | US
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Telephone | 661-466-2390
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Fax |
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Provider Business Mailing Address
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Address Line | 763 2ND ST
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City | FILLMORE
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State | CA
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Zip | 93015-1244
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Country | US
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Telephone | 580-341-0917
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 53204
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License Number State | CA
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