Provider Demographics
NPI:1497799233
Name:LINOWSKI, DALE CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:CHARLES
Last Name:LINOWSKI
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 1:2314 E BEACHCOMBER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2883
Mailing Address - Country:US
Mailing Address - Phone:480-663-3982
Mailing Address - Fax:480-663-3982
Practice Address - Street 1:4323 E BROADWAY RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3506
Practice Address - Country:US
Practice Address - Phone:480-854-9833
Practice Address - Fax:480-854-9834
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0297870OtherBCBS
AZS87646Medicare UPIN
AZAZ0297870OtherBCBS