Provider Demographics
NPI:1457810574
Name:DOWD, DALTON J
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:J
Last Name:DOWD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W158N6711 TAMARACK TRL
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-5005
Mailing Address - Country:US
Mailing Address - Phone:262-442-1899
Mailing Address - Fax:
Practice Address - Street 1:8 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13699-1401
Practice Address - Country:US
Practice Address - Phone:262-442-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer