Provider Demographics
NPI:1477648616
Name:DALTON, BRITT M (PT)
Entity Type:Individual
Prefix:MR
First Name:BRITT
Middle Name:M
Last Name:DALTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-285-6647
Practice Address - Street 1:1904 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5402
Practice Address - Country:US
Practice Address - Phone:865-983-8129
Practice Address - Fax:865-983-8293
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9452568OtherPRIVATE HEALTHCARE SYSTEM
TN3646922Medicaid
TN4135954OtherBLUE CROSS BLUESHIELD
TNCH4394OtherMEDICARE-RAILROAD GROUP ID
9452568OtherPRIVATE HEALTHCARE SYSTEM