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General NPI Number Information
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NPI Number | 1841846383
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Entity Type | Individual
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Provider Name | DALTON JARED BOLAND DPT
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Gender | Male
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2011 YORK RD STE 1500
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City | OAK BROOK
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State | IL
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Zip | 60523-2156
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Country | US
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Telephone | 877-632-6637
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Fax | 708-409-5179
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Provider Business Mailing Address
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Address Line | PO BOX 735263
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City | CHICAGO
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State | IL
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Zip | 60673-5263
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Country | US
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Telephone | 877-632-6637
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Fax | 708-409-5179
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070028907
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 096848
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License Number State | IA
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