Provider Demographics
NPI:1942063367
Name:RAYBURN, HAILY LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:HAILY
Middle Name:LYNN
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HAILY
Other - Middle Name:LYNN
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4460 MARCY LN APT 88
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-5009
Mailing Address - Country:US
Mailing Address - Phone:219-604-1195
Mailing Address - Fax:
Practice Address - Street 1:965 EMERSON PKWY STE G
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6274
Practice Address - Country:US
Practice Address - Phone:317-324-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015376A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist