Provider Demographics
NPI:1154753663
Name:HAYNES, JESSICA STACEY (DPT)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:STACEY
Last Name:HAYNES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 NAPIER ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3932
Mailing Address - Country:US
Mailing Address - Phone:313-530-3296
Mailing Address - Fax:305-689-5930
Practice Address - Street 1:8901 ROCKVILLE PIKE
Practice Address - Street 2:BLDG 19, ROOM B323
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889
Practice Address - Country:US
Practice Address - Phone:301-295-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist