Provider Demographics
NPI:1164638540
Name:CARRION, HAYDENISE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:HAYDENISE
Middle Name:
Last Name:CARRION
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 LOOKOUT LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2883
Mailing Address - Country:US
Mailing Address - Phone:321-945-5703
Mailing Address - Fax:407-552-3965
Practice Address - Street 1:2670 LOOKOUT LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2883
Practice Address - Country:US
Practice Address - Phone:321-945-5703
Practice Address - Fax:407-552-3965
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist