Individual
DEREK DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002703
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2693183
BCBS
WV
05
—
3810023134
—
WV
Enumeration date
01/11/2012
Last updated
07/06/2012
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