Healthcare Provider Details

I. General information

NPI: 1164339362
Provider Name (Legal Business Name): DASHAWN HATALLA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N ESTRELLA PKWY
GOODYEAR AZ
85338-9272
US

IV. Provider business mailing address

20251 W TONTO ST
BUCKEYE AZ
85326-8254
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-2992
  • Fax:
Mailing address:
  • Phone: 602-642-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-015171
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: