Basic Information
| Provider Information | |||||||||
| NPI: | 1184641722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALTON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ROWLAND | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROWLAND | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | YOUNG | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 32709 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379302709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655586484 | ||||||||
| FaxNumber: | 8655844037 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 OAK RIDGE TPKE | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654827730 | ||||||||
| FaxNumber: | 8654810531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7583 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4131987 | 01 | TN | BLUECROSS BLUESHIELD OF T | OTHER | 3646757 | 05 | TN | MEDICAID | CH4394 | 01 | TN | MEDICARE-RAILROAD GROUP ID | OTHER | 4145988446 | 01 | TN | CHAMPUS TRICARE | OTHER |