Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 295722 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 295722 | CA |
NPI | 1225505894 |
---|---|
Provider Name | Dr. Haley Tarryn Hawes |
First Address | Los Angeles, CA 90025-1015 |
Second Address | Los Angeles, CA 90025-1015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2018 |
Last Update Date | 31/05/2019 |