Provider Demographics
NPI:1912187287
Name:HAYES, BRETT E (MSPT,)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:E
Last Name:HAYES
Suffix:
Gender:M
Credentials:MSPT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 W. MCMILLAN ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1080
Mailing Address - Country:US
Mailing Address - Phone:208-887-8684
Mailing Address - Fax:208-887-9226
Practice Address - Street 1:3035 W. MCMILLAN ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1080
Practice Address - Country:US
Practice Address - Phone:208-887-8684
Practice Address - Fax:208-887-9226
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID820520880OtherTRICARE
ID807962600Medicaid
IDTD821OtherBLUE CROSS
ID000010171917OtherREGENCE BLUE SHIELD
ID000010171917OtherREGENCE BLUE SHIELD