Provider Demographics
NPI:1821018904
Name:HAYWOOD, SUE JANE (PT)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:JANE
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:JANE
Other - Last Name:HAYWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:#9 BELLENGRATH COURT
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1625
Mailing Address - Country:US
Mailing Address - Phone:903-295-0036
Mailing Address - Fax:903-295-0099
Practice Address - Street 1:9 BELLENGRATH DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1625
Practice Address - Country:US
Practice Address - Phone:903-295-0036
Practice Address - Fax:903-295-0099
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist