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General NPI Number Information
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NPI Number | 1407254774
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Entity Type | Organization
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Legal Business Name | DALTON PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 9705 WYETH CT
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City | WELLINGTON
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State | FL
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Zip | 33414-6401
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Country | US
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Telephone | 561-223-7467
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Fax | 561-214-4469
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Provider Business Mailing Address
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Address Line | 9705 WYETH CT
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City | WELLINGTON
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State | FL
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Zip | 33414-6401
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Country | US
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Telephone | 561-223-7467
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Fax | 561-214-4469
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC THOMAS DALTON
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Credential | DPT
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Telephone | 561-223-7467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 26696
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License Number State | FL
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