Provider Demographics
NPI:1174042162
Name:WIDMAN, HAYLEY ANN (MSK, LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:HAYLEY
Middle Name:ANN
Last Name:WIDMAN
Suffix:
Gender:F
Credentials:MSK, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S HAMILTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44847-9409
Mailing Address - Country:US
Mailing Address - Phone:419-677-3848
Mailing Address - Fax:
Practice Address - Street 1:410 BAYTREE RD APT 30F
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-3235
Practice Address - Country:US
Practice Address - Phone:419-677-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
GAAT0036632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer