Provider Demographics
NPI:1205039401
Name:HORRICKS, DALE J (PT)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:HORRICKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 OKEEFE ST
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2638
Mailing Address - Country:US
Mailing Address - Phone:650-853-5028
Mailing Address - Fax:650-326-8323
Practice Address - Street 1:1899 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6130
Practice Address - Country:US
Practice Address - Phone:650-326-9080
Practice Address - Fax:650-326-8323
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT240100Medicare ID - Type Unspecified