Provider Demographics
NPI:1083808224
Name:DUX, JACLYN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:DUX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 RIVER VISTA PL
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3006
Mailing Address - Country:US
Mailing Address - Phone:208-734-7333
Mailing Address - Fax:208-734-8350
Practice Address - Street 1:254 RIVER VISTA PL
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-7333
Practice Address - Fax:208-734-8350
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT2231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist