Provider Demographics
NPI:1184641722
Name:DALTON, JENNIFER ROWLAND (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROWLAND
Last Name:DALTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:YOUNG
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 32709
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2709
Mailing Address - Country:US
Mailing Address - Phone:865-558-6484
Mailing Address - Fax:865-584-4037
Practice Address - Street 1:1030 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6804
Practice Address - Country:US
Practice Address - Phone:865-482-7730
Practice Address - Fax:865-481-0531
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4131987OtherBLUECROSS BLUESHIELD OF T
TN3646757Medicaid
TNCH4394OtherMEDICARE-RAILROAD GROUP ID
TN4145988446OtherCHAMPUS TRICARE
TN3646757Medicaid