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General NPI Number Information
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NPI Number | 1922537570
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Entity Type | Organization
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Legal Business Name | LJ HAYNES COMPANY
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 1115 FORT WORTH HWY STE 1200
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City | WEATHERFORD
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State | TX
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Zip | 76086-4570
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Country | US
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Telephone | 817-594-9200
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Fax | 817-594-9202
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Provider Business Mailing Address
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Address Line | PO BOX 237
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City | WEATHERFORD
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State | TX
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Zip | 76086-0237
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Country | US
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Telephone | 817-594-9200
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Fax | 817-594-9202
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Authorized Official
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Title or Position | SECRETARY
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Name | ASHTYN SAMANTHA HAYNES
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Credential | MSCPM
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Telephone | 817-594-9200
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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 |
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License Number State |
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