Healthcare Provider Details

I. General information

NPI: 1649846452
Provider Name (Legal Business Name): DALTON LOUKOTA DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 NE DOUGLAS ST
LEES SUMMIT MO
64086-4602
US

IV. Provider business mailing address

PO BOX 650020, DEPT 5093
DALLAS TX
75265-0020
US

V. Phone/Fax

Practice location:
  • Phone: 816-875-3884
  • Fax: 816-524-5080
Mailing address:
  • Phone: 816-875-3884
  • Fax: 816-524-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021019716
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: