Provider Demographics
NPI:1487481156
Name:DALTON, HEATHER (LMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N BEERS ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1500
Mailing Address - Country:US
Mailing Address - Phone:908-692-3181
Mailing Address - Fax:
Practice Address - Street 1:721 N BEERS ST STE 2E
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1500
Practice Address - Country:US
Practice Address - Phone:908-692-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00572200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist