Individual
MARK GLENN HAYNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
302 LEATHERWOOD DR, MOUNTAIN HOME, AR 72653-3702
(870) 424-3554
Mailing address
302 LEATHERWOOD DR, MOUNTAIN HOME, AR 72653-3702
(870) 424-3554
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
128
AR
Other
Enumeration date
12/21/2006
Last updated
07/08/2007
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