Provider Demographics
NPI:1700253390
Name:TEW, DALLAS
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:
Last Name:TEW
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DALLAS
Other - Middle Name:
Other - Last Name:TEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:7581 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-5939
Mailing Address - Country:US
Mailing Address - Phone:850-453-9475
Mailing Address - Fax:850-453-9673
Practice Address - Street 1:1921 ORTEGA ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-4111
Practice Address - Country:US
Practice Address - Phone:850-936-8919
Practice Address - Fax:850-936-8936
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30764225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT30764OtherDOCTORATE PHYSICAL THERAPY