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Individual

DALTON JANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, DPT, CERT. DN

Contact information

Practice address
1031 LAKE COUNTRY DR, GREENSBORO, GA 30642-5157
(706) 549-1663
Mailing address
1765 OLD WEST BROAD ST BLDG 2-200, ATHENS, GA 30606-2887
(706) 549-1663
(706) 546-8792

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT017349
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
16267034
CAQH NUMBER
Enumeration date
07/30/2024
Last updated
09/03/2024
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