Basic Information
| Provider Information | |||||||||
| NPI: | 1811465685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAYS | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MPT, CLT, CCI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | IVA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296559765 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 406 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | IVA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296559765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643487433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2018 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5172 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.