Provider Demographics
NPI:1114196144
Name:HAYNES, RICHARD ALAN (LPTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:HAYNES
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 ALBACETE CIR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8950
Mailing Address - Country:US
Mailing Address - Phone:961-575-9610
Mailing Address - Fax:941-575-8714
Practice Address - Street 1:3725 ALBACETE CIR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-8950
Practice Address - Country:US
Practice Address - Phone:961-575-9610
Practice Address - Fax:941-575-8714
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA12622225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant