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General NPI Number Information
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NPI Number | 1164339362
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Entity Type | Individual
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Provider Name | DASHAWN HATALLA PTA
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Gender | Male
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 750 N ESTRELLA PKWY
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City | GOODYEAR
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State | AZ
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Zip | 85338-9272
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Country | US
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Telephone | 623-882-2992
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Fax |
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Provider Business Mailing Address
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Address Line | 20251 W TONTO ST
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City | BUCKEYE
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State | AZ
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Zip | 85326-8254
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Country | US
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Telephone | 602-642-9750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA-015171
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License Number State | AZ
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