Provider Demographics
NPI:1306356282
Name:DALTON, LEGAITHER MICHELLE
Entity type:Individual
Prefix:
First Name:LEGAITHER
Middle Name:MICHELLE
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-9219
Mailing Address - Country:US
Mailing Address - Phone:276-340-9753
Mailing Address - Fax:
Practice Address - Street 1:123 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-9219
Practice Address - Country:US
Practice Address - Phone:276-340-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver