Provider Demographics
NPI:1104695691
Name:LENOX, DALTON JAMES (PTA)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:JAMES
Last Name:LENOX
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5845
Mailing Address - Country:US
Mailing Address - Phone:918-423-1181
Mailing Address - Fax:
Practice Address - Street 1:221 E COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5845
Practice Address - Country:US
Practice Address - Phone:918-423-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3686225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant