Provider Demographics
NPI:1790732030
Name:HAYAG, GUILLERMO B (PT-C)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:B
Last Name:HAYAG
Suffix:
Gender:M
Credentials:PT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 BOWDEN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8070
Mailing Address - Country:US
Mailing Address - Phone:904-634-0929
Mailing Address - Fax:904-634-0203
Practice Address - Street 1:10475 CENTURION PKWY N
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5003
Practice Address - Country:US
Practice Address - Phone:904-634-0929
Practice Address - Fax:904-634-0203
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00163070OtherRAILROAD MEDICARE
FLP00163070OtherRAILROAD MEDICARE
FLP15028Medicare UPIN