Provider Demographics
NPI:1841038700
Name:CALLEBS, DALTON TAYLOR (PT)
Entity type:Individual
Prefix:DR
First Name:DALTON
Middle Name:TAYLOR
Last Name:CALLEBS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1427
Mailing Address - Country:US
Mailing Address - Phone:606-622-1468
Mailing Address - Fax:606-546-6910
Practice Address - Street 1:209 KNOX ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1427
Practice Address - Country:US
Practice Address - Phone:606-622-1468
Practice Address - Fax:606-546-6910
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist