Provider Demographics
NPI:1891755112
Name:DUTTON, EVERETT SHAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:EVERETT
Middle Name:SHAYNE
Last Name:DUTTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10817 LOS RIOS DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179
Mailing Address - Country:US
Mailing Address - Phone:817-236-1561
Mailing Address - Fax:
Practice Address - Street 1:1208 S FM 51
Practice Address - Street 2:STE B
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-2408
Practice Address - Country:US
Practice Address - Phone:940-627-7554
Practice Address - Fax:940-627-7582
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist