Provider Demographics
NPI:1437574035
Name:DALTON, CRYSTAL-JEANETTE N (DPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL-JEANETTE
Middle Name:N
Last Name:DALTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CRYSTAL-JEANETTE
Other - Middle Name:N
Other - Last Name:WHISENANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1001 E WILSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3157
Mailing Address - Country:US
Mailing Address - Phone:630-761-0900
Mailing Address - Fax:
Practice Address - Street 1:992 TAMIAMI TRL UNIT H2
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3868
Practice Address - Country:US
Practice Address - Phone:941-888-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist