Provider Demographics
NPI:1487130639
Name:HAYNES, TABITHA (CMT,MMP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4187 VT ROUTE 100 S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05767-9304
Mailing Address - Country:US
Mailing Address - Phone:802-558-9499
Mailing Address - Fax:
Practice Address - Street 1:106 VT ROUTE 107
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05772-6701
Practice Address - Country:US
Practice Address - Phone:802-558-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist