Provider Demographics
NPI:1659730786
Name:HAINES, CARLA (DPT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1906
Mailing Address - Country:US
Mailing Address - Phone:830-798-3497
Mailing Address - Fax:830-798-3499
Practice Address - Street 1:1316 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5058
Practice Address - Country:US
Practice Address - Phone:830-798-3497
Practice Address - Fax:830-798-3499
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1271428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist