Provider Demographics
NPI:1174931562
Name:HAYNES, MEGAN BROOKE (MED, MS, ATC LAT)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:BROOKE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MED, MS, ATC LAT
Other - Prefix:
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Mailing Address - Street 1:601 UNIVERSITY DR
Mailing Address - Street 2:JOWERS CENTER A134
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4684
Mailing Address - Country:US
Mailing Address - Phone:512-245-3761
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:JOWERS CENTER A134
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4684
Practice Address - Country:US
Practice Address - Phone:512-245-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT39342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer