Healthcare Provider Details

I. General information

NPI: 1821907841
Provider Name (Legal Business Name): DALTON RAY MAGNANI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 N PORTWEST ST
WICHITA KS
67204-2357
US

IV. Provider business mailing address

1103 W MCFARLAND ST
HILL CITY KS
67642-2234
US

V. Phone/Fax

Practice location:
  • Phone: 785-734-7104
  • Fax:
Mailing address:
  • Phone: 785-734-7104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-03624
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: