Provider Demographics
NPI:1366021206
Name:SHINGLER, DALLIS (PT)
Entity Type:Individual
Prefix:MR
First Name:DALLIS
Middle Name:
Last Name:SHINGLER
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 1:4005 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3312
Mailing Address - Country:US
Mailing Address - Phone:520-247-8748
Mailing Address - Fax:
Practice Address - Street 1:21391 N LAKE PLEASANT PKWY STE 1810
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2000
Practice Address - Country:US
Practice Address - Phone:623-334-8767
Practice Address - Fax:623-566-5993
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist