Basic Information
| Provider Information | |||||||||
| NPI: | 1639233109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | KIRK | ||||||||
| MiddleName: | JACQUINE | ||||||||
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| Credential: | ATC MPT CERT MDT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 OAK ST | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582017012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017806000 | ||||||||
| FaxNumber: | 7017801942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 S COLUMBIA RD | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582014036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017806000 | ||||||||
| FaxNumber: | 7017805345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6391 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1139 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.