Provider Demographics
NPI:1730469982
Name:DALE, JUDITH K (MSPT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:DALE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2306 KNOLLWAY DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4300
Mailing Address - Country:US
Mailing Address - Phone:641-753-3304
Mailing Address - Fax:641-484-3103
Practice Address - Street 1:1708 HARDING ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-1028
Practice Address - Country:US
Practice Address - Phone:641-484-4061
Practice Address - Fax:641-484-3103
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist