Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 5406 | SC |
NPI | 1073689675 |
---|---|
Provider Name | Kristine Weir Haynes |
First Address | Aiken, SC 29803-8421 |
Second Address | Aiken, SC 29803-8421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |