Provider Demographics
NPI:1760407894
Name:HAYNIE, MERTHIA I (DPT)
Entity Type:Individual
Prefix:
First Name:MERTHIA
Middle Name:I
Last Name:HAYNIE
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 197
Mailing Address - Street 2:
Mailing Address - City:CALLAO
Mailing Address - State:VA
Mailing Address - Zip Code:22435-0197
Mailing Address - Country:US
Mailing Address - Phone:804-529-5178
Mailing Address - Fax:
Practice Address - Street 1:765 NORTHUMBERLAND HWY
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435-2206
Practice Address - Country:US
Practice Address - Phone:804-529-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009402331Medicaid
VA250404OtherBCBS PROVIDER ID
VA20091OtherSENTARA
VA541726590OtherCOMMERCIAL/WC CARRIER