Provider Demographics
NPI:1528419652
Name:DIBBLE, TRUDI M (PT ASSISTANT)
Entity Type:Individual
Prefix:
First Name:TRUDI
Middle Name:M
Last Name:DIBBLE
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11893 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-6999
Mailing Address - Country:US
Mailing Address - Phone:570-723-0675
Mailing Address - Fax:
Practice Address - Street 1:11893 ROUTE 6
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6999
Practice Address - Country:US
Practice Address - Phone:570-723-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001937225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant