MEDICARE: DUSTIN HALEY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070022049	IL

General Provider Information

NPI Number	:	1073033254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN HALEY DPT

Provider Business Mailing Address
First Line	:	714 W BARRY AVE APT GDN
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5147
Country	:	US
Telephone Number	:	773-975-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	01/08/2026

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