Healthcare Provider Details

I. General information

NPI: 1437732914
Provider Name (Legal Business Name): DALTON A BOATRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 KILLINGSWORTH WAY
THE VILLAGES FL
32162-2175
US

IV. Provider business mailing address

4470 SE 150TH ST
SUMMERFIELD FL
34491-3991
US

V. Phone/Fax

Practice location:
  • Phone: 352-633-2971
  • Fax:
Mailing address:
  • Phone: 352-207-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA30928
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number30928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: