Provider Demographics
NPI:1700495280
Name:VALLE, DALLAN (DPT)
Entity Type:Individual
Prefix:
First Name:DALLAN
Middle Name:
Last Name:VALLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-5830
Mailing Address - Country:US
Mailing Address - Phone:775-777-1276
Mailing Address - Fax:775-777-7022
Practice Address - Street 1:248 COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815
Practice Address - Country:US
Practice Address - Phone:775-777-1276
Practice Address - Fax:775-777-7022
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist