Provider Demographics
NPI:1952641565
Name:HAYAG, MARVIN DONNIE (PT)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:DONNIE
Last Name:HAYAG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 N KENDALL DR APT B501
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7810
Mailing Address - Country:US
Mailing Address - Phone:347-387-5859
Mailing Address - Fax:
Practice Address - Street 1:5900 SW 73RD ST STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5149
Practice Address - Country:US
Practice Address - Phone:305-446-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14132225100000X
FLPT275012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist