MEDICARE: EMILY WAYE DALTON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1294961	TX

General Provider Information

NPI Number	:	1245758481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY WAYE DALTON PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 1805
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76101-1805
Country	:	US
Telephone Number	:	832-723-8347
Fax Number	:	817-582-4266

Provider Business Practice Location Address
First Line	:	3204 COLLINSWORTH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6528
Country	:	US
Telephone Number	:	832-723-8347
Fax Number	:	817-582-4266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	03/15/2021

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