Provider Demographics
NPI:1063646735
Name:HAYWARD, TAKARA (DPT)
Entity Type:Individual
Prefix:
First Name:TAKARA
Middle Name:
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DEFENSE HWY
Mailing Address - Street 2:STE 150
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8953
Mailing Address - Country:US
Mailing Address - Phone:443-481-5618
Mailing Address - Fax:
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3629
Practice Address - Country:US
Practice Address - Phone:410-910-2351
Practice Address - Fax:410-730-2379
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD715MMedicare PIN