Provider Demographics
NPI:1326574997
Name:PAVLIK, DALE ROBERT (CO)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ROBERT
Last Name:PAVLIK
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD CLAIRTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-3912
Mailing Address - Country:US
Mailing Address - Phone:412-532-7500
Mailing Address - Fax:
Practice Address - Street 1:25 OLD CLAIRTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-3912
Practice Address - Country:US
Practice Address - Phone:412-532-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOH000014222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist