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General NPI Number Information
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NPI Number | 1023636081
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Entity Type | Individual
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Provider Name | HAYDEN GLEN DATWYLER DPT
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Gender | Male
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 124 PETERSEN PKWY
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City | THAYNE
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State | WY
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Zip | 83127-9754
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Country | US
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Telephone | 307-883-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S 700 E
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City | RIVER HEIGHTS
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State | UT
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Zip | 84321-5632
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Country | US
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Telephone | 435-760-0048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11803315-2401
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License Number State | UT
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