Provider Demographics
NPI:1770368748
Name:MCCUAN, HAYDEN
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:MCCUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 W UNIVERSITY PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1618
Mailing Address - Country:US
Mailing Address - Phone:731-300-4950
Mailing Address - Fax:
Practice Address - Street 1:176 W UNIVERSITY PKWY STE E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1618
Practice Address - Country:US
Practice Address - Phone:731-300-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8418225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant