Provider Demographics
NPI:1508954249
Name:NELSON, DALE S (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:S
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-2227
Mailing Address - Country:US
Mailing Address - Phone:509-659-1200
Mailing Address - Fax:509-659-1252
Practice Address - Street 1:903 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-2227
Practice Address - Country:US
Practice Address - Phone:509-659-1200
Practice Address - Fax:509-659-1252
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025208 PT00002721225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA92453OtherL & I
WA603272500OtherFED WORKERS
WA7105174Medicaid
WA92453OtherL & I
WAG000301791Medicare PIN