Provider Demographics
NPI:1659924413
Name:WOMACK, HAYLEE RENEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HAYLEE
Middle Name:RENEE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HAYLEE
Other - Middle Name:RENEE
Other - Last Name:THIBODEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:4337 BUTLER HILL RD STE L
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3735
Practice Address - Country:US
Practice Address - Phone:314-487-7000
Practice Address - Fax:314-487-7001
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019025907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist