Individual
DALTON DERTHICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS
Contact information
Practice address
4703 S LAKESHORE DR STE 2, TEMPE, AZ 85282-7159
(480) 718-9493
Mailing address
4703 S LAKESHORE DR STE 2, TEMPE, AZ 85282-7159
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
13226PT
AZ
Other
Enumeration date
08/11/2017
Last updated
09/06/2017
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