=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568332591
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALTON R DOWDEN PTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1872 HIGHWAY 171
-----------------------------------------------------
City | STONEWALL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71078-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-540-8549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1872 HIGHWAY 171
-----------------------------------------------------
City | STONEWALL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71078-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-540-8549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A12151
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------