Basic Information
| Provider Information | |||||||||
| NPI: | 1760079412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYTON PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 BLUE HAVEN LN | ||||||||
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| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897014851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287136923 | ||||||||
| FaxNumber: | 7757475005 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 DOUGLAS ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894036783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287136923 | ||||||||
| FaxNumber: | 7757475005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2020 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | TUTTLE | ||||||||
| AuthorizedOfficialFirstName: | MICAHEL | ||||||||
| AuthorizedOfficialMiddleName: | CHARLES | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9287136923 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.