Provider Demographics
NPI:1811095557
Name:HAYNES, STEPHEN PATRICK (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6535 W CAMELBACK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033
Mailing Address - Country:US
Mailing Address - Phone:623-873-4000
Mailing Address - Fax:623-873-9000
Practice Address - Street 1:6535 W CAMELBACK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033
Practice Address - Country:US
Practice Address - Phone:623-873-4000
Practice Address - Fax:623-873-9000
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101749Medicare ID - Type Unspecified