Provider Demographics
NPI:1417926494
Name:HAYES, ANNA (MPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7905
Mailing Address - Country:US
Mailing Address - Phone:757-474-1249
Mailing Address - Fax:757-474-0193
Practice Address - Street 1:4560 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7905
Practice Address - Country:US
Practice Address - Phone:757-474-1249
Practice Address - Fax:757-474-0193
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01158400225100000X
VA2305204784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080009Medicare ID - Type Unspecified