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General NPI Number Information
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NPI Number | 1457128308
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Entity Type | Individual
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Provider Name | MOLLY J DALTON PTA
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Gender | Female
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 18 N FORT THOMAS AVE STE 302
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City | FORT THOMAS
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State | KY
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Zip | 41075-1595
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Country | US
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Telephone | 859-441-0139
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Fax |
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Provider Business Mailing Address
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Address Line | 218 ALLISON AVE
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City | FLORENCE
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State | KY
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Zip | 41042-1506
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Country | US
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Telephone | 859-779-3125
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A03984
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License Number State | KY
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