Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 8944 | MA |
NPI | 1003020272 |
---|---|
Provider Name | Todd A Haynes |
First Address | Merrimac, MA 01860-1864 |
Second Address | Merrimac, MA 01860-1864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |