Provider Demographics
NPI:1376375097
Name:POWER, HAILEY DIANE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:DIANE
Last Name:POWER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BROAD ST APT 3P
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4773
Mailing Address - Country:US
Mailing Address - Phone:302-353-9026
Mailing Address - Fax:
Practice Address - Street 1:4200 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1049
Practice Address - Country:US
Practice Address - Phone:203-365-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist