Provider Demographics
NPI:1407254774
Name:DALTON PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DALTON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-223-7467
Mailing Address - Street 1:9705 WYETH CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6401
Mailing Address - Country:US
Mailing Address - Phone:561-223-7467
Mailing Address - Fax:561-214-4469
Practice Address - Street 1:9705 WYETH CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6401
Practice Address - Country:US
Practice Address - Phone:561-223-7467
Practice Address - Fax:561-214-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 225200000X, 225X00000X
FL26696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty