MEDICARE: MRS. REBECCA SUE HAYWORTH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	35.127886	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699017731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA SUE HAYWORTH M.D.

Provider Business Mailing Address
First Line	:	998 S DORSET RD STE 104
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-4748
Country	:	US
Telephone Number	:	937-332-8843
Fax Number	:	937-332-8982

Provider Business Practice Location Address
First Line	:	998 S DORSET RD STE 104
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-4748
Country	:	US
Telephone Number	:	937-332-8843
Fax Number	:	937-332-8982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	12/11/2019

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