MEDICARE: DR. JACQUELINE HAYDUK PT, 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

General Provider Information

NPI Number	:	1215452958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE HAYDUK PT, DPT

Provider Business Mailing Address
First Line	:	901 ADAMS ST
Second Line	:
City	:	AFTON
State	:	WY
Zip	:	83110-9621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 FEATHER WAY
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-9352
Country	:	US
Telephone Number	:	307-789-0096
Fax Number	:

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	09/23/2025

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