Provider Demographics
NPI:1578039228
Name:VANHOOSE, DALE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:VANHOOSE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6159 FM 1001
Mailing Address - Street 2:
Mailing Address - City:COOKVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75558-3047
Mailing Address - Country:US
Mailing Address - Phone:903-573-6954
Mailing Address - Fax:
Practice Address - Street 1:6159 FM 1001
Practice Address - Street 2:
Practice Address - City:COOKVILLE
Practice Address - State:TX
Practice Address - Zip Code:75558-3047
Practice Address - Country:US
Practice Address - Phone:903-573-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2033454225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant