Provider Demographics
NPI:1235843798
Name:HAYDEN, ANDREW K (PT ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 LAKENGREN DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2903
Mailing Address - Country:US
Mailing Address - Phone:812-346-5303
Mailing Address - Fax:
Practice Address - Street 1:501 W LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9274
Practice Address - Country:US
Practice Address - Phone:937-456-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011639225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant