Individual
SHANTI T DALSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1815 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 647-1700
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05010469A
IN
2251X0800X
Orthopedic Physical Therapist
Primary
05010469A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000915279
BCBS BMG IRELAND RD
IN
05
—
201276420
—
IN
Enumeration date
02/11/2015
Last updated
03/07/2016
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