Provider Demographics
NPI:1225374341
Name:TEMPLE, DOLORES A (PT)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:A
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 TRUSSVILLE CLAY RD
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1547
Mailing Address - Country:US
Mailing Address - Phone:205-222-5560
Mailing Address - Fax:
Practice Address - Street 1:4555 TRUSSVILLE CLAY RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1547
Practice Address - Country:US
Practice Address - Phone:205-222-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist