Provider Demographics
NPI:1861457103
Name:HAYNES, LYDIA (PT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 DAHLKE DR
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3625
Mailing Address - Country:US
Mailing Address - Phone:256-739-1370
Mailing Address - Fax:256-739-1956
Practice Address - Street 1:1387 STATE HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-4437
Practice Address - Country:US
Practice Address - Phone:205-647-6849
Practice Address - Fax:205-647-4574
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH415225100000X
AL415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK531OtherGROUP NPI
AL529917620Medicaid
ALK531OtherGROUP NPI
AL051530539Medicare ID - Type Unspecified