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General NPI Number Information
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NPI Number | 1902047582
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Entity Type | Individual
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Provider Name | NANCY JANE HAYNES PTA
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Gender | Female
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 3500 PARK ST
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City | GREENVILLE
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State | TX
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Zip | 75401-5159
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Country | US
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Telephone | 903-455-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 EASTLAND ST
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City | GREENVILLE
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State | TX
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Zip | 75402-8919
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Country | US
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Telephone | 903-217-7947
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Fax | 903-454-7537
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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 | 2069680
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License Number State | TX
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