Provider Demographics
NPI:1629449525
Name:BALENSEIFEN, HAYLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:BALENSEIFEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 BENTHAM CT
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7929
Mailing Address - Country:US
Mailing Address - Phone:580-704-9750
Mailing Address - Fax:
Practice Address - Street 1:1809 BENTHAM CT
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7929
Practice Address - Country:US
Practice Address - Phone:580-704-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist