MEDICARE: DR. LUKE JASON HAYNES 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	1092740	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689671612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUKE JASON HAYNES PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 237
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-0237
Country	:	US
Telephone Number	:	817-594-9200
Fax Number	:	817-594-9202

Provider Business Practice Location Address
First Line	:	1115 FORT WORTH HWY STE 1200
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086
Country	:	US
Telephone Number	:	817-594-9200
Fax Number	:	817-594-9202

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/05/2018

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