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General NPI Number Information
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NPI Number | 1972720357
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Entity Type | Individual
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Provider Name | HAILEY K. HIMES
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 609 E ORANGEBURG AVE 101
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City | MODESTO
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State | CA
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Zip | 95350-5512
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Country | US
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Telephone | 209-572-3224
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Fax | 209-572-4528
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Provider Business Mailing Address
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Address Line | 609 E ORANGEBURG AVE 101
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City | MODESTO
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State | CA
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Zip | 95350-5512
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Country | US
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Telephone | 209-572-3224
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Fax | 209-572-4528
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 33556
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License Number State | CA
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