Provider Demographics
NPI:1699261933
Name:H.B DALTON, LLC
Entity type:Organization
Organization Name:H.B DALTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, LE
Authorized Official - Phone:541-622-8057
Mailing Address - Street 1:1517 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7568
Mailing Address - Country:US
Mailing Address - Phone:541-778-7889
Mailing Address - Fax:541-622-8058
Practice Address - Street 1:1722 E MCANDREWS RD STE B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5500
Practice Address - Country:US
Practice Address - Phone:541-622-8057
Practice Address - Fax:541-622-8058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H.B DALTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13153225700000X
ORCAE-P-10182922247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty