Provider Demographics
NPI:1376021733
Name:HAYES, LEAH (ATC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 SIMPSON STUART RD APT 3202
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-5047
Mailing Address - Country:US
Mailing Address - Phone:972-904-5099
Mailing Address - Fax:
Practice Address - Street 1:3245 SIMPSON STUART RD APT 3202
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-5047
Practice Address - Country:US
Practice Address - Phone:972-904-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT76032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer