Provider Demographics
NPI:1134806839
Name:HAYNIE, KAYLA NOELLE (PTA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NOELLE
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:BURGESS
Mailing Address - State:VA
Mailing Address - Zip Code:22432-0283
Mailing Address - Country:US
Mailing Address - Phone:804-761-1082
Mailing Address - Fax:
Practice Address - Street 1:2400 MCKINNEY BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL BEACH
Practice Address - State:VA
Practice Address - Zip Code:22443-1237
Practice Address - Country:US
Practice Address - Phone:804-224-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant