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General NPI Number Information
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NPI Number | 1427245703
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Entity Type | Individual
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Provider Name | JASON ADAM HAYNES PTA
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Gender | Male
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 213 W MAIN ST
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City | PARSONS
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State | TN
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Zip | 38363-2018
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Country | US
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Telephone | 731-847-8825
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Fax | 731-847-8828
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Provider Business Mailing Address
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Address Line | 2535 SMITHS CHAPEL RD
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City | DECATURVILLE
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State | TN
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Zip | 38329-4656
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Country | US
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Telephone |
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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 | 3124
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License Number State | TN
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