Provider Demographics
NPI:1639586589
Name:HAYDEN, YSELA BENOIT (PTA)
Entity Type:Individual
Prefix:
First Name:YSELA
Middle Name:BENOIT
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 CORK DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-4641
Mailing Address - Country:US
Mailing Address - Phone:915-594-4485
Mailing Address - Fax:
Practice Address - Street 1:9912 CORK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-4641
Practice Address - Country:US
Practice Address - Phone:915-594-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21010502251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics