Provider Demographics
NPI:1821570417
Name:HAYCOCK, KRISTOPHER COLLIN (DPT)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:COLLIN
Last Name:HAYCOCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:COLLIN
Other - Last Name:HAYCOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2210 E RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4150
Mailing Address - Country:US
Mailing Address - Phone:559-840-2704
Mailing Address - Fax:
Practice Address - Street 1:221 W FIR AVE STE 105
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0223
Practice Address - Country:US
Practice Address - Phone:559-325-3444
Practice Address - Fax:559-325-7444
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist