Provider Demographics
NPI:1760079412
Name:DAYTON PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DAYTON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICAHEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-713-6923
Mailing Address - Street 1:2555 BLUE HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4851
Mailing Address - Country:US
Mailing Address - Phone:928-713-6923
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:140 DOUGLAS ST STE 1
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-6783
Practice Address - Country:US
Practice Address - Phone:928-713-6923
Practice Address - Fax:775-747-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty