Individual
DR. DUSTYN SLADE LEE WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Contact information
Practice address
921 S 8TH AVE, POCATELLO, ID 83209-0002
(307) 696-5885
Mailing address
921 S 8TH AVE, STOP 8619 APT. I1, POCATELLO, ID 83209
(307) 696-5885
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
—
—
2255A2300X
Athletic Trainer
LAT-5681
NC
Other
Enumeration date
11/27/2021
Last updated
01/30/2025
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