Provider Demographics
NPI:1477872216
Name:DALE, ROBERT BARRY (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BARRY
Last Name:DALE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 BRIDGE MOORE DR
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-8387
Mailing Address - Country:US
Mailing Address - Phone:901-448-3356
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVENUE SUITE 415
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0002
Practice Address - Country:US
Practice Address - Phone:901-448-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36562251X0800X, 2251S0007X
ALPTH73172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic