Healthcare Provider Details

I. General information

NPI: 1316248529
Provider Name (Legal Business Name): THOMAS MICHAEL DEYTON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 G STREET
SALIDA CO
81201
US

IV. Provider business mailing address

305 G ST
SALIDA CO
81201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 719-221-8287
  • Fax:
Mailing address:
  • Phone: 719-221-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2283
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2283
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: