Provider Demographics
NPI:1922537570
Name:LJ HAYNES COMPANY
Entity type:Organization
Organization Name:LJ HAYNES COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ASHTYN
Authorized Official - Middle Name:SAMANTHA
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MSCPM
Authorized Official - Phone:817-594-9200
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0237
Mailing Address - Country:US
Mailing Address - Phone:817-594-9200
Mailing Address - Fax:817-594-9202
Practice Address - Street 1:1115 FORT WORTH HWY STE 1200
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4570
Practice Address - Country:US
Practice Address - Phone:817-594-9200
Practice Address - Fax:817-594-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty