Provider Demographics
NPI:1881369171
Name:SMITH, DALTON ALAN (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:1409 HIGHWAY 62 65 N STE 4
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1970
Practice Address - Country:US
Practice Address - Phone:870-704-4076
Practice Address - Fax:870-741-0089
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCP011613T225100000X
ARPT5005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist