Provider Demographics
NPI:1902221310
Name:HAYNES, DAVID ALAN JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:HAYNES
Suffix:JR
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 1:314 GOFF MOUNTAIN RD. (STE 13)
Mailing Address - Street 2:STE 13
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313
Mailing Address - Country:US
Mailing Address - Phone:304-776-5031
Mailing Address - Fax:304-204-6332
Practice Address - Street 1:314 GOFF MOUNTAIN RD. (STE 13)
Practice Address - Street 2:STE 13
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313
Practice Address - Country:US
Practice Address - Phone:304-776-5031
Practice Address - Fax:304-204-6332
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT2942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810027186Medicaid