Provider Demographics
NPI:1588695720
Name:HAYES, CHARLES STEVEN (PT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STEVEN
Last Name:HAYES
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:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05444-0152
Mailing Address - Country:US
Mailing Address - Phone:802-644-5803
Mailing Address - Fax:
Practice Address - Street 1:272 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444
Practice Address - Country:US
Practice Address - Phone:802-644-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011659Medicaid
VTVN3737Medicare ID - Type Unspecified