Provider Demographics
NPI:1619285749
Name:DIBBLE, LORRAINE (PT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:DIBBLE
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 1:670 GOLD SPUR ST
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1009
Mailing Address - Country:US
Mailing Address - Phone:631-835-3811
Mailing Address - Fax:
Practice Address - Street 1:670 GOLD SPUR ST
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1009
Practice Address - Country:US
Practice Address - Phone:631-835-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006653225100000X
FL25032225100000X
PA779-E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist