Individual
DEREK DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
560 MAIN STREET, CHAPMANVILLE, WV 25508
(304) 928-1446
Mailing address
PO BOX 945, CHAPMANVILLE, WV 25508-0945
(304) 928-1446
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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