Provider Demographics
NPI:1902461593
Name:HAYES, STEPHANIE NICOLE HEAD (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE HEAD
Last Name:HAYES
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 1:1127 BONITA ST
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-3046
Mailing Address - Country:US
Mailing Address - Phone:949-422-0688
Mailing Address - Fax:
Practice Address - Street 1:131 E 100 S
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2641
Practice Address - Country:US
Practice Address - Phone:435-210-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist