Provider Demographics
NPI:1619181252
Name:DEPUE, DALE PARIS (PT)
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:PARIS
Last Name:DEPUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2513
Mailing Address - Country:US
Mailing Address - Phone:910-297-1346
Mailing Address - Fax:910-270-0942
Practice Address - Street 1:427 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-2513
Practice Address - Country:US
Practice Address - Phone:910-297-1346
Practice Address - Fax:910-270-0942
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2504461AMedicare ID - Type UnspecifiedPT PROVIDER PART B