Provider Demographics
NPI:1295777258
Name:DALTON, ALAN DANIEL (PT, MPT, OCS)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:DANIEL
Last Name:DALTON
Suffix:
Gender:M
Credentials:PT, MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 PINEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7123
Mailing Address - Country:US
Mailing Address - Phone:941-484-8107
Mailing Address - Fax:941-484-5186
Practice Address - Street 1:834 PINEBROOK RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7123
Practice Address - Country:US
Practice Address - Phone:941-484-8107
Practice Address - Fax:941-484-5186
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113134Medicaid
FL6698562OtherGHI INDIV PROV NUM
FLY9227OtherBCBS INDIV PROV NUM
FL8874859000Medicaid
FLY9227OtherBCBS INDIV PROV NUM
FL113134Medicaid