Provider Demographics
NPI:1801022157
Name:HAYDEN III, EDWARD N (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:N
Last Name:HAYDEN III
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 HARBOUR VIEW BLVD # D
Mailing Address - Street 2:SUITE0150
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3315
Mailing Address - Country:US
Mailing Address - Phone:757-215-1400
Mailing Address - Fax:757-215-1403
Practice Address - Street 1:5818 HARBOUR VIEW BLVD # D
Practice Address - Street 2:SUITE0150
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-215-1400
Practice Address - Fax:757-215-1403
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192074OtherANTHEM BLUE CROSS BLUE SHIELD
VA10019389OtherOPTIMA