Provider Demographics
NPI:1295795995
Name:CORDIAL, DALE JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:JAMES
Last Name:CORDIAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:438 PELLIS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7900
Mailing Address - Country:US
Mailing Address - Phone:724-850-7587
Mailing Address - Fax:724-850-8329
Practice Address - Street 1:520 PELLIS RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4777
Practice Address - Country:US
Practice Address - Phone:724-838-1008
Practice Address - Fax:724-832-1690
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003251L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016000620004Medicaid
PA0016000620004Medicaid
PAR05805Medicare UPIN