Provider Demographics
NPI:1356550511
Name:DALE, DEBORAH LYNN (PT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:DALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 MAIDEN CHOICE LANE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-247-1888
Mailing Address - Fax:410-247-1889
Practice Address - Street 1:817 MAIDEN CHOICE LANE
Practice Address - Street 2:SUITE 270
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-247-1888
Practice Address - Fax:410-247-1889
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD15547208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation