Provider Demographics
NPI:1336459833
Name:HAYNES, SHENITA DENISE (DPT, CEEAA)
Entity Type:Individual
Prefix:
First Name:SHENITA
Middle Name:DENISE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:DPT, CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 BOULDER HWY
Mailing Address - Street 2:STE. 2-F # 279
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122
Mailing Address - Country:US
Mailing Address - Phone:702-831-8076
Mailing Address - Fax:
Practice Address - Street 1:730 W KATHRYN AVE
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-1759
Practice Address - Country:US
Practice Address - Phone:702-831-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY62029858225100000X
NV3011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist