Provider Demographics
NPI:1366036378
Name:RICHARDSON, HAILEY B
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:B
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:B
Other - Last Name:STOCKTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4350 E RAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4703
Mailing Address - Country:US
Mailing Address - Phone:595-448-0704
Mailing Address - Fax:
Practice Address - Street 1:4350 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4703
Practice Address - Country:US
Practice Address - Phone:595-448-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics