Provider Demographics
NPI:1851700900
Name:DALLATORE, DANIEL (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DALLATORE
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TYLER DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3068
Mailing Address - Country:US
Mailing Address - Phone:724-584-3307
Mailing Address - Fax:
Practice Address - Street 1:227 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6093
Practice Address - Country:US
Practice Address - Phone:540-585-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT52292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic