Provider Demographics
NPI:1639383391
Name:DIPOLD, DAX JOSEF (PT)
Entity Type:Individual
Prefix:
First Name:DAX
Middle Name:JOSEF
Last Name:DIPOLD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15140 LOUISVILLE ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44634-9626
Mailing Address - Country:US
Mailing Address - Phone:330-821-2877
Mailing Address - Fax:
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-489-1135
Practice Address - Fax:330-430-6972
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist