Basic Information
| Provider Information | |||||||||
| NPI: | 1811621535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATHCOCK | ||||||||
| FirstName: | HALEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 257 BANCORP SOUTH PKWY | ||||||||
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| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383057582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316608781 | ||||||||
| FaxNumber: | 7316608739 | ||||||||
| Practice Location | |||||||||
| Address1: | 614 CARRIAGE HOUSE DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383054238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316684449 | ||||||||
| FaxNumber: | 7316608739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2022 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14180 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.