Provider Demographics
NPI:1205061934
Name:DALTON, JEAN A (LMT, MMP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:DALTON
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7216 US HIGHWAY 301 N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3462
Mailing Address - Country:US
Mailing Address - Phone:941-448-1408
Mailing Address - Fax:
Practice Address - Street 1:7216 US HIGHWAY 301 N
Practice Address - Street 2:SUITE 108
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3462
Practice Address - Country:US
Practice Address - Phone:941-448-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA35633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist