Provider Demographics
NPI:1245660638
Name:DALE, JOHN LUTHER III (PT, DPT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LUTHER
Last Name:DALE
Suffix:III
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 FRANCISCAN WAY
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-9703
Mailing Address - Country:US
Mailing Address - Phone:814-472-3936
Mailing Address - Fax:814-472-3905
Practice Address - Street 1:108 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-9703
Practice Address - Country:US
Practice Address - Phone:814-472-3936
Practice Address - Fax:814-472-3905
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist