Provider Demographics
NPI:1821102765
Name:SMITH, DALE WAYNE (PT)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:WAYNE
Last Name:SMITH
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:PO BOX 670846
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367-0846
Mailing Address - Country:US
Mailing Address - Phone:214-695-8847
Mailing Address - Fax:214-368-0653
Practice Address - Street 1:12404 PARK CENTRAL DRIVE
Practice Address - Street 2:SUITE 150S
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251
Practice Address - Country:US
Practice Address - Phone:214-695-8847
Practice Address - Fax:214-368-0653
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10364242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83367TOtherBLUE CROSS/BLUE SHIELD
TX83367TOtherBLUE CROSS/BLUE SHIELD