Provider Demographics
NPI:1083708895
Name:DALTON, ASHLEIGH WILSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:WILSON
Last Name:DALTON
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 1:2008 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-2750
Mailing Address - Country:US
Mailing Address - Phone:423-747-6047
Mailing Address - Fax:
Practice Address - Street 1:2008 WILLOW RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2750
Practice Address - Country:US
Practice Address - Phone:423-747-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4660OtherBCBS PROVIDER NUMBER