Provider Demographics
NPI:1689856486
Name:ALBERT, DALE JACQUELINE
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:JACQUELINE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TEMPLE STREET
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-873-5939
Mailing Address - Fax:207-872-9227
Practice Address - Street 1:18 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6629
Practice Address - Country:US
Practice Address - Phone:207-873-5939
Practice Address - Fax:207-872-9227
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME9710117172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist