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General NPI Number Information
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NPI Number | 1437732914
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Entity Type | Individual
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Provider Name | DALTON A BOATRIGHT
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 1550 KILLINGSWORTH WAY
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City | THE VILLAGES
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State | FL
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Zip | 32162-2175
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Country | US
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Telephone | 352-633-2971
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Fax |
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Provider Business Mailing Address
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Address Line | 4470 SE 150TH ST
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City | SUMMERFIELD
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State | FL
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Zip | 34491-3991
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Country | US
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Telephone | 352-207-9762
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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 | PTA30928
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License Number State | FL
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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 | 30928
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License Number State | FL
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