Provider Demographics
NPI:1982395034
Name:HAYSLEY, TRAVIS (PT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:HAYSLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ROCKY POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3637
Mailing Address - Country:US
Mailing Address - Phone:804-878-0691
Mailing Address - Fax:
Practice Address - Street 1:7061 COMMONS PLZ STE A
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6462
Practice Address - Country:US
Practice Address - Phone:214-580-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist