Provider Demographics
NPI:1073593893
Name:HAYNES, DAVID E (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:708 24TH AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6232
Mailing Address - Country:US
Mailing Address - Phone:405-321-5969
Mailing Address - Fax:405-321-5967
Practice Address - Street 1:700 NW 7TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1212
Practice Address - Country:US
Practice Address - Phone:405-609-3675
Practice Address - Fax:800-506-3795
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPT 2087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249506605Medicare ID - Type Unspecified