Provider Demographics
NPI:1437286325
Name:HAYNES, MARJORIE PRIM (PT,DPT, MA, PCS)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:PRIM
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PT,DPT, MA, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-9414
Mailing Address - Country:US
Mailing Address - Phone:910-895-7850
Mailing Address - Fax:910-895-7850
Practice Address - Street 1:207 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-9414
Practice Address - Country:US
Practice Address - Phone:910-895-7850
Practice Address - Fax:910-895-7850
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8472251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212694Medicaid