Provider Demographics
NPI:1235897968
Name:CARTER, DALTON (DPT)
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 N 400 E STE 400
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3440
Mailing Address - Country:US
Mailing Address - Phone:435-833-9070
Mailing Address - Fax:435-243-7375
Practice Address - Street 1:2321 N 400 E STE 400
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3440
Practice Address - Country:US
Practice Address - Phone:435-833-9070
Practice Address - Fax:435-243-7375
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12565347-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist