Provider Demographics
NPI:1457744930
Name:BHALE, DIPTI
Entity Type:Individual
Prefix:
First Name:DIPTI
Middle Name:
Last Name:BHALE
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 1:38 S MAIN ST
Mailing Address - Street 2:APT A
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5031
Mailing Address - Country:US
Mailing Address - Phone:630-466-5866
Mailing Address - Fax:630-466-5869
Practice Address - Street 1:465 W LEATHER AVE APT 5
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2270
Practice Address - Country:US
Practice Address - Phone:405-714-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12236-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist