MEDICARE: MARC T DALTON D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	26696	FL

General Provider Information

NPI Number	:	1154448694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC T DALTON D.P.T.

Provider Business Mailing Address
First Line	:	12110 COLONY PRESERVE DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-5804
Country	:	US
Telephone Number	:	203-982-9878
Fax Number	:

Provider Business Practice Location Address
First Line	:	5155 W ATLANTIC AVE STE C
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8170
Country	:	US
Telephone Number	:	561-637-7195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/12/2011

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