Provider Demographics
NPI:1093199275
Name:HAYMARKET PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:HAYMARKET PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-719-3563
Mailing Address - Street 1:14535 JOHN MARSHALL HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4025
Mailing Address - Country:US
Mailing Address - Phone:703-753-0261
Mailing Address - Fax:
Practice Address - Street 1:14535 JOHN MARSHALL HWY
Practice Address - Street 2:203
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4023
Practice Address - Country:US
Practice Address - Phone:703-753-0974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty