Provider Demographics
NPI:1437974474
Name:HAYES, JACOB THOMAS (ATC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:HAYES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2032
Mailing Address - Country:US
Mailing Address - Phone:707-477-4864
Mailing Address - Fax:
Practice Address - Street 1:3000 MOUNTAIN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-6700
Practice Address - Country:US
Practice Address - Phone:707-477-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT99022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer