=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679175426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATTHEW S HAYES PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2020
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 WATER ST STE 201
-----------------------------------------------------
City | MASSENA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13662-2181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 153-603-0339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 340
-----------------------------------------------------
City | NEW HARTFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13413-0340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW S HAYES
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 315-603-0339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------