Provider Demographics
NPI:1093961344
Name:HAYNES, DEEANNA JEAN (PTA)
Entity Type:Individual
Prefix:MS
First Name:DEEANNA
Middle Name:JEAN
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 ROSEBUD LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9283
Mailing Address - Country:US
Mailing Address - Phone:812-473-4761
Mailing Address - Fax:812-473-5184
Practice Address - Street 1:5233 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9283
Practice Address - Country:US
Practice Address - Phone:812-473-4761
Practice Address - Fax:812-473-5184
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002777A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant