Provider Demographics
NPI:1073824181
Name:HAYNES, DARREN R (PT)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:R
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1240
Mailing Address - Country:US
Mailing Address - Phone:606-329-0910
Mailing Address - Fax:
Practice Address - Street 1:1200 RICHLAND DR
Practice Address - Street 2:SUITE G
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-8008
Practice Address - Country:US
Practice Address - Phone:254-772-0118
Practice Address - Fax:254-772-3883
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1230197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist