Individual
CHASE GASTON HAYNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1120 RITCHIE AVE, CLARKSDALE, MS 38614-7535
(662) 621-1447
Mailing address
71 RIDGECREST DR, POPE, MS 38658-3150
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTA-6504
MS
Other
Enumeration date
12/30/2020
Last updated
12/30/2020
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