Provider Demographics
NPI:1477632412
Name:DALE, STEVEN EUGENE (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:EUGENE
Last Name:DALE
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 1:307 S 12TH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3139
Mailing Address - Country:US
Mailing Address - Phone:509-453-3103
Mailing Address - Fax:509-453-2057
Practice Address - Street 1:307 S 12TH AVE STE 5
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3139
Practice Address - Country:US
Practice Address - Phone:509-453-3103
Practice Address - Fax:509-453-2057
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1477632412Medicaid
WA0258827OtherWASHINGTON L&I
WA4496OtherGROUP HEALTH
WA79292OtherLABOR & INDUSTRY
WA8335952Medicaid
WA0258827OtherWASHINGTON L&I
WA4496OtherGROUP HEALTH
WA8335952Medicaid