Provider Demographics
NPI:1093186579
Name:DALE, HANNAH KATHERINE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:KATHERINE
Last Name:DALE
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 1:54463 FOXTROT AVE
Mailing Address - Street 2:
Mailing Address - City:KNOX CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63446-4036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55774, 6 STATE HWY D
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537
Practice Address - Country:US
Practice Address - Phone:660-397-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015024298225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant