Provider Demographics
NPI:1205147428
Name:VALA HAYNES, BELEN NANCY (DPT)
Entity type:Individual
Prefix:MS
First Name:BELEN
Middle Name:NANCY
Last Name:VALA HAYNES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BELEN
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:17700 SE MILL PLAIN BLVD STE 150
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7582
Practice Address - Country:US
Practice Address - Phone:360-514-9383
Practice Address - Fax:360-514-0193
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60518151225100000X
OR6307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2041413Medicaid
ORP01310145OtherRR MEDICARE
WAP01740354OtherRR MEDICARE
OR500628535Medicaid
WA2041413Medicaid
ORR164118Medicare PIN
WAG8936224Medicare PIN