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NPI Code Detail

MEDICARE: DUSTIN HALEY DPT

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
1225100000XPhysical Therapist070022049IL

General Provider Information

NPI Number : 1073033254
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN HALEY DPT
Provider Business Mailing Address
First Line : 2828 N CAMBRIDGE AVE APT 410
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6051
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1401 S CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1858
Country : US
Telephone Number : 773-542-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2017
Last Update Date : 06/20/2017

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