Provider Demographics
NPI:1508236852
Name:CAMPBELL, HALEY MARIE (BS, PTA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BS, PTA
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3013 CLAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8740
Mailing Address - Country:US
Mailing Address - Phone:936-465-3288
Mailing Address - Fax:
Practice Address - Street 1:915 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:214-547-1517
Practice Address - Fax:214-547-7328
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111867225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant