Provider Demographics
NPI:1316136526
Name:DEAN, GIZELLE A (PT)
Entity type:Individual
Prefix:
First Name:GIZELLE
Middle Name:A
Last Name:DEAN
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 1:1005 CAMPUS CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-7901
Mailing Address - Country:US
Mailing Address - Phone:724-346-1529
Mailing Address - Fax:724-346-1498
Practice Address - Street 1:1005 CAMPUS CIR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-7901
Practice Address - Country:US
Practice Address - Phone:724-346-1529
Practice Address - Fax:724-346-1498
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009233E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117357S6ROtherMEDICARE
PADE2363OtherHIGHMARK
PA117357S6ROtherMEDICARE