Provider Demographics
NPI:1316360589
Name:DALDE, ROY
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:DALDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 INLAND CT
Mailing Address - Street 2:APARTMENT #4
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3602 INLAND CT
Practice Address - Street 2:APARTMENT #4
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1231
Practice Address - Country:US
Practice Address - Phone:541-248-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist